Presidential candidates’ ACA plans

When it comes to the candidates vying for president, there’s one thing they have in common: They want to make changes to the Affordable Care Act (ACA). However, while the Democrats say they want to make improvements to the existing law, the Republicans say they want to repeal it. Here’s a closer look at what they’ve vowed to do if elected to the Oval Office.

Related:

• Republican candidates: Healthcare views at a glance

Democratic candidates: Healthcare views at a glance

Hillary Clinton

Clinton plans to defend the ACA against Republicans’ efforts to revoke it. By building upon it, she says she will expand coverage for millions of Americans, slowing the growth of healthcare costs.

Some key efforts, according to her website, include:

Making health insurance purchased on the Obamacare exchanges more affordable. Specifically, Clinton says she intends to make premiums more reasonable and reduce out-of-pocket expenses, such as copays and deductibles. She also wants to provide greater relief for consumers using the exchanges, by enhancing current premium tax credits so eligible Americans would pay a smaller percentage of their income. Families who use exchange plans wouldn’t spend more than 8.5% of their income for premiums. She would also reduce the cost of prescription drugs by cracking down on rising prescription drug prices and holding drug companies accountable.

Supporting new incentives to encourage all states to expand Medicaid. Clinton would follow President Obama’s proposal to permit any state that signs up for Medicaid expansion to receive a 100% match for the first three years. She also says she plans to incentivize states to expand Medicaid in other ways.

Making other changes to the ACA. Clinton would work with governors, using current flexibility under the ACA, to empower states to establish a public option choice to reduce costs and broaden insurance coverage options. By investing in navigators, advertising, and other outreach activities, enrolling in exchanges would become easier, her website says. Families would have greater access to affordable healthcare, regardless of their immigration status.

From a provider perspective, Clinton plans to transform the healthcare system to reward value and quality, which builds upon the ACA’s delivery system reforms. In addition, she would explore cost-effective ways to broaden the scope of healthcare providers who are eligible for telehealth reimbursement under Medicare and other programs.

Next: Ted Cruz

Ted Cruz

Cruz provided some details about his healthcare plan during the January 28 debate on Fox News. Specifically, he said as president he would “repeal every word of Obamacare.” Subsequently, healthcare reform would be needed, he said, adding that “It should follow the principles of expanding competition, empowering patients, and keeping government from getting between us and our doctors.”

Three specific reforms would reflect those principles. They include:

• Allowing people to purchase health insurance across state lines, which would create a true 50-state national marketplace while driving down the cost of low-cost catastrophic health insurance.

• Expanding HSAs to allow people to save in a tax-advantaged way for more routine healthcare needs. 

• Delinking health insurance from employment, so if someone loses his or her job, their health insurance would go with them.

The goal is to have insurance that is personal, portable, and affordable is key, Cruz concludes.

Next: John Kasich

John Kasich

Like his GOP rivals, Governor Kasich would repeal Obamacare if elected president. His goal would be to improve access by lowering healthcare costs while returning control of healthcare choices to patients and giving states full control of insurance market regulation. Key points of his new plan would include:

• Having a primary care system that promotes long-term good health rather than simply reacting when someone becomes ill. This would prevent costs, and health insurance plans could realize savings.

• Rewarding value instead of volume. Even if primary care payment reform would occur, high-cost episodes would continue to account for most healthcare spending. Today, all of these inputs are paid for as separate episodes. But if these inputs were considered as a whole, then the providers involved would be motivated to work as a team to control costs and maximize quality.

On his website, Kasich says Ohio’s model provides a path forward for the nation: patient-centered care, choices, market competition, decentralized decision-making, higher quality, respect for individuals, and an end to Obamacare’s big government interference.

Next: Bernie Sanders

Bernie Sanders

Sanders wants to build upon the ACA and create a universal healthcare system. His plan calls for separating health insurance from employment-creating a federally administered single-payer healthcare program that provides comprehensive coverage for all Americans.

The tax break provided by healthcare from employers would disappear because all Americans would receive healthcare through the new program rather than employer-based healthcare. According to Sanders’ website, the plan has multiple benefits:

Advantages to patients. Patients would no longer have copays or deductibles. They could choose a healthcare provider without worrying about whether he or she is in network.

A simplified payment structure would provide incentives to find new ways to make sure patients get better care, which in turn would generate significant savings.

Under the plan, a family of four earning $50,000 would pay $466 per year to the single-payer program, amounting to a savings of more than $5,800 annually.

Advantages to the U.S. government. Sanders maintains that by having an integrated system, the U.S. government would be able to negotiate fair prices with drug companies for Americans collectively. His plan would also enable the government to track access to various providers and make smart investments to avoid provider shortages.

Sanders’ plan, estimated to cost $1.38 trillion per year, would be fully paid for by a 6.2% income-based healthcare premium paid by employers; a 2.2% income-based premium paid by households; progressive income tax rates; taxing capital gains and dividends the same as income from work; limited tax deductions for the wealthy; an estate tax; and savings from health tax expenditures.

Next: Donald Trump

Donald Trump

If elected to the Oval Office, Trump says he would ask Congress to completely repeal Obamacare on his first day. His administration would work with Congress to ensure that reforms adhering to free market principles are implemented. By doing this, in addition to working together to create sound public policy, he believes he can broaden healthcare access, make healthcare more affordable, and improve the quality of care.

Trump’s website states that he would ask representatives in the House and Senate to:

• Change existing law that hinders the sale of health insurance across state lines.

• Allow individuals to fully deduct health insurance premiums from their tax returns under the current tax system.

• Allow individuals to use health savings accounts (HSAs). Contributions to HSAs would be tax free and be permitted to accumulate.

• Require price transparency from all healthcare providers, especially physicians and healthcare organizations such as clinics and hospitals. Individuals would have the ability to shop to find the best prices for procedures and exams.

• Block-grant Medicaid to the states. State governments would better manage the administration of Medicaid without federal overhead, according to his website.

• Remove barriers for pharmaceutical providers to enter into free markets that offer safe, reliable, and cheaper products. Consumers would have more options if they are allowed access to imported, safe, and dependable drugs, according to Trump.

Trump maintains that these reforms would lower healthcare costs for all Americans. Actions would also be needed in other policy areas to lower healthcare costs and burdens, such as enforcing immigration laws.  

Another priority is to reform mental health programs and institutions. Trump expects promising reforms being developed in Congress to receive bipartisan support.

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.