5 Key Differences Between the Candidates on Healthcare

Healthcare hasn’t been a top issue in the 2016 presidential race, but that doesn’t mean the candidates don’t have ideas. Both nominees, Democrat Hillary Clinton and Republican Donald Trump, have position statements on how they would drive down the cost of prescription drugs, ensure access, and pay for health premiums. While the candidates agree somewhat on what the problems are, their approaches are vastly different. Here are 5 key differences in the candidates’ healthcare plans, based on their published proposals.

1.      The future of the Affordable Care Act (ACA). This is the most basic difference: Clinton wants to keep or even expand the ACA, while Trump has called for a complete repeal, especially the individual mandate. Clinton wants caps on out-of-pocket costs for drugs as well as a “public option,” something discussed and rejected when the ACA passed. (However, President Barack Obama recently wrote that it should be reconsidered to address market gaps.) Trump has not addressed every aspect of how he would replace the ACA; his proposals include market-based reforms like health savings accounts, along with deducting premiums from income taxes for those who can afford healthcare.

 

2.      Approaches to Medicaid. Clinton has called for more incentives for the 19 holdout states that have not expanded Medicaid to those earning up to 138% of the federal poverty level, but she is less specific on what this would entail. Trump’s agenda points appear to conflict with one another: first, he calls for block grants for Medicaid, a longtime GOP goal, because states “know their people best.” Then, he says the federal government should review basic Medicaid options with states, because, “we must also make sure that no one slips through the cracks simply because they cannot afford insurance.”

 

3.      Controlling prescription drug costs. Both candidates say this is top concern, and they even agree on one controversial solution: allowing Americans to buy drugs from overseas. Beyond that, the chief difference is the level of detail. Clinton has a full agenda to combat rising drug prices, which includes more power for Medicare to negotiate, tying federal research help to limits on profits and marketing, ending ads directed at consumers, and advancing generic drugs. Trump’s platform says simply, “Congress will need the courage to step away from the special interests and do what is right for America.”

 

4.      Healthcare can’t escape the immigration debate. Trump’s message to curb illegal immigration and “build a wall” on the Mexican border finds its way into his healthcare platform. Providing healthcare to those here illegally costs $11 billion a year, he claims. Enforcing current laws and restricting “the unbridled granting of visas” would relieve cost pressures on state government, Trump said. Clinton, meanwhile, wants to let people buy coverage on the health insurance exchanges regardless of immigration status.

 

5.      Attention grabbers (or not). Both candidates have policy ideas that in a normal year would command headlines. For Trump, it’s a proposal he offered in the very first televised debate–a call to allow businesses to buy coverage across state lines. The concept of an “optional federal charter” has been around for nearly 20 years and is a rare example of how Trump’s business experience translates into a serious policy proposal. For Clinton, her call to let Americans as young as 55 years old “buy into Medicare” has received almost no attention, even though it could vastly change both that program and the private health insurance market.