As president, Hillary Clinton and Donald Trump would take the nation down distinctly different paths on health care. In this post, we summarize the health reform proposals of each candidate, and—drawing on new estimates by Christine Eibner and colleagues at RAND Health—compare the proposals’ implications for the total number of people with insurance coverage, people’s out-of-pocket health care costs, and the federal budget.
RAND’s analysis is based on publicly available health care proposals on the candidates’ websites. Where these proposals lacked sufficient clarity for modeling, RAND sought additional information from the campaigns. When answers were not forthcoming, or did not fully resolve questions, RAND made reasonable assumptions that were reviewed and critiqued by independent experts. RAND modeled only those proposals for which it had adequate detail and technical capacity.
The Starting Point
As a starting point, Clinton and Trump propose dramatically different approaches to the Affordable Care Act (ACA): Clinton would maintain the ACA and Trump would repeal it. In estimating the impact of Trump’s proposal, RAND assumes a full repeal of the law including insurance subsidies, expanded eligibility for Medicaid, and individual market reforms such as bans against preexisting condition exclusions. RAND also assumes that repeal would eliminate the ACA’s financing mechanisms such as its Medicare payment reforms and taxes on health plans and medical devices. Consequently, RAND estimates that compared to maintaining the ACA as is, repeal would cause nearly 20 million people to lose their insurance in 2018, increase average premium and out-of-pocket costs for people who buy insurance on their own, and increase the federal deficit. Trump’s repeal of the ACA would increase the federal deficit because the loss of savings from the law’s Medicare reforms and revenues from fees and taxes would be greater than savings from the elimination of insurance subsidies and the Medicaid expansion.
