Comparing the 2016 Presidential Candidates’ Health Proposals

Presidential candidates Hillary Clinton and Donald Trump have proposed distinctly different approaches to health care policy. The table below highlights the key differences, as well as RAND’s estimated impact of selected proposals on coverage, people’s average out-of-pockets costs (premium costs plus cost-sharing), and the federal deficit for the year 2018. The estimated effects of Clinton’s proposals are calculated based on maintaining the Affordable Care Act (ACA), whereas the estimated effects of Trump’s proposals are calculated based on ACA repeal. The ACA includes the Medicaid expansion and tax credits for health plans purchased in the insurance marketplaces, as well as market reforms such as bans on coverage denials to individuals with preexisting conditions. It also incorporates revenue generated through penalties for enforcing individual and employer mandates, reduced Medicare spending, and new taxes and fees.

Hillary Clinton’s Health Care Reform Proposals Donald Trump’s Health Care Reform Proposals

Approach to the Affordable Care Act

Maintain the ACA.

Repeal the ACA.


ACA Enhancements or Replacements:

ACA health insurance marketplaces/individual market reforms

Add government-administered public insurance plan to compete with private plans in the marketplaces.


Invest $500 million annually in an enrollment campaign.
Allow people to purchase marketplace plans regardless of immigration status.
Permit insurers to sell health insurance across state lines.


Medicaid reforms

100% federal match for enrollees who qualify under the Medicaid expansion (covering adults up to 138% of the poverty level) for the first three years, regardless of start date. While Medicaid is jointly funded by federal and state governments, under current law the federal government pays 100% of health care costs for enrollees who qualify under the expansion through 2016. After that, the federal match tapers down to 90% by 2020.
Fund Medicaid through block grants to states with fixed amounts.

Ensure that no one slips through the cracks because they cannot afford insurance.
Review basic options for Medicaid and work with states to ensure that those who want coverage can have it.

Employer-sponsored coverage

Repeal “Cadillac tax” on high-cost employer health plans.
Expand eligibility for small-business tax credit to firms with up to 50 workers, up from a limit of 25 workers.

Medicare reforms

Allow people ages 55 and older to buy into Medicare, which is currently open only to people ages 65 and older and people with disabilities.

Affordability of premiums

Enhance premium tax credits, so that enrollees pay no more than 8.5% of their income toward premiums, down from 9.66%.


Fix the so-called “family glitch” for marketplace tax credits whereby families with access to employer coverage are eligible for tax credits only if the worker’s premium contribution for single enrollee’s coverage exceeds the affordability threshold, which would be set at 8.5% of income consistent with the proposed change to premium tax credits. Because family contributions often exceed single contributions, many families are left with unaffordable coverage. The impact is the combined effect of the fix and the enhanced premium tax credits.


Strengthen ability of states to modify or block premium rate hikes.
Vigorously enforce antitrust laws in health care markets.
Make all health insurance premium payments tax deductible, rather than just premiums for employer-sponsored plans.


Establish state high-risk pools, available to people who have not maintained continuous coverage.

Affordability of out-of-pocket costs and deductibles

Provide a refundable tax credit to help insured Americans pay for qualifying out-of-pocket costs that exceed 5% of income. The credit, up to $2,500 for an individual and $5,000 for a family, would be available to people who are not eligible for Medicare and do not claim existing deductions for medical costs.


Require that insurers and employers exclude up to three sick visits per year from the plan deductible.
Provide protections from surprise medical bills by ensuring that consumers cannot be charged more than in-network cost-sharing for care received in a hospital, and for a medical emergency.
Ensure that consumers have up-to-date information to help them select health plans, understand out-of-pocket costs, choose doctors, and make other informed decisions about their coverage and health care.
Expand health saving accounts (HSAs) and consider them part of an individual’s estate, with no penalties for passing the accounts on to surviving family members or for allowing any family member to use the funds.

Affordability of prescription drugs

Require that health plans cap out-of-pocket spending on covered prescription drugs at $250 a month.
End corporate tax write-offs for direct-to-consumer drug advertising.
Require drug companies that receive federal support to invest a sufficient amount of their revenue in R&D.
Allow imported drugs for personal use if they meet federal quality and safety standards.
Clear Food and Drug Administration generic backlog and reduce biologic exclusivity periods.
Prohibit “pay-for-delay” arrangements that allow drug manufacturers to keep generic competition off the market.
Raise Medicare rebates for low-income enrollees to the more generous levels currently offered in Medicaid.
Let Medicare negotiate drug prices.
Ensure drug prices reflect the value of drugs.
Remove barriers to market entry for drug providers.
Allow imported drugs for personal use if they meet safety standards.

Mental health and substance abuse

Strengthen enforcement of 2008 mental health parity law that requires insurers to cover mental illness the same way they cover physical illness by using insurer audits and compliance monitoring, and by making it easier for consumers to report violations.
Improve integration and coordination of mental and physical health care systems through collaborative payment approaches.
Launch $7.5 billion fund to support new federal-state partnerships over 10 years to prevent and treat addiction.
Increase the Substance Abuse Prevention and Treatment Block Grant by $2.5 billion over 10 years to expand in- and out-patient substance abuse care.
Allow nurse practitioners and physician assistants to prescribe medications for opioid addiction.
Reform our mental health programs and institutions.

Long-term care and Alzheimer’s disease

Tax credits of up to $6,000 to offset family caregiving costs.
Apply a credit toward caregivers’ Social Security benefits for the time they are out of the paid workforce taking care of a family member.
Invest $100 million over 10 years in Caregiver Respite program, which provides respite for family caregivers of children and adults.
Cover comprehensive Alzheimer’s care-planning services and help coordinate care among physicians.
Reauthorize the Missing Alzheimer’s Disease Patient Alert Program for patients who wander.

Delivery system reforms and reducing health care costs

Double funding over 10 years for primary care services at community health centers and triple size of National Health Service Corps to increase the primary care workforce in underserved areas.
Build on reforms to reward value and quality, such as bundled payments and accountable care organizations.
Expand value-based delivery system reform in Medicare and Medicaid and support efforts that incentivize employers and private insurers to adopt these payment models.
Broaden scope of providers and services eligible for telehealth payments.
Make price and quality information more transparent.
Eliminate fraud and abuse.
Require price transparency from all health care providers so that people can shop for the best prices for medical services.
Eliminate fraud and waste.
Enforce immigration laws.
Create a patient-centered health care system promoting choice, quality, and affordability.