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Credit: Michael Vadon - https://commons.wikimedia.org/wiki/File:Mr_Donald_Trump_New_Hampshire_Town_Hall_on_August_19th,_2015_at_Pinkerton_Academy,_Derry,_NH_by_Michael_Vadon_02.jpg

This article examines the differences between the proposed Trumpcare platform and those of his opponent, Hillary Clinton. Trumpcare is not only a response to Obamacare, but also to Hillarycare.

Donald Trump was asked at the 8th Republican presidential primary debate to elaborate upon how his healthcare platform (at that point undisclosed) compares to Hillary Clinton's (and Bernie Sanders'):

"I think I'm closer to common sense [than to Hillary Clinton's healthcare platform]. We are going to repeal Obamacare. ... We are going to replace Obamacare with something so much better. And there are so many examples of it. And I will tell you, part of the reason we have some people laughing, because you have insurance people that take care of everybody up here. I am self-funded. The only one they're not taking care of is me. We have our lines around each state. The insurance companies are getting rich on Obamacare. The insurance companies are getting rich on health care and health services and everything having to do with health. We are going to end that. We're going to take out the artificial boundaries, the artificial lines. We're going to get a plan where people compete, free enterprise. They compete. So much better. In addition to that, you have the health care savings plans, which are excellent. What I do say is, there will be a certain number of people that will be on the street dying and as a Republican, I don't want that to happen. We're going to take care of people that are dying on the street because there will be a group of people that are not going to be able to even think in terms of private or anything else and we're going to take care of those people. And I think everybody on this stage would have to agree, you're not going to let people die, sitting in the middle of a street in any city in this country."[1]

Trump Takes Aim at Insurance Companies

Almost half of Trump's policy points relate directly to the free market and how to reduce the control insurance and pharmaceutical companies have over the American healthcare marketplace. While Trump has the marketplace dominated by insurance and pharmaceutical companies in his crosshairs, Clinton is raking in their cash. From the start of the presidential campaign up to March 2016, Clinton has received $3.5 million in donations from lobbyists in the insurance and pharmaceutical industries.[2] From the beginning of her campaigning career as a New York senator until now, Clinton has raked in over $13 million from the health industry overall.[3] Clinton supports the Affordable Care Act, and has expressed motivation to increase competition in the marketplace through initiatives like opening up the ability for consumers to purchase pharmaceuticals from other countries.

Hillary's Healthcare Platform Highlights

Clinton's platform is straightforward, as to be expected. She will defend the Affordable Care Act, she will fight to lower rising prescription drug costs and she will protect women's access to reproductive health care. Additionally, she has stated that she will:

  • Make premiums more affordable and lessen out-of-pocket expenses for consumers purchasing health insurance on the Obamacare exchanges.
  • Support new incentives to encourage all states to expand Medicaid.
  • Invest in navigators, advertising and other outreach activities to make enrollment easier.
  • Expand access to affordable health care to families regardless of immigration status.
  • Lower out-of-pocket costs like co-pays and deductibles.
  • Reduce the cost of prescription drugs.
  • Expand access to rural Americans, who often have difficulty finding quality, affordable health care.
  • Continue to support a “public option”—and work to build on the Affordable Care Act to make it possible.[4]

Hillarycare Gets Specific

Clinton will make premiums more affordable. "Her plan will provide enhanced relief for people on the exchanges, and provide a tax credit of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above 5% of their income. She will enhance the premium tax credits now available through the exchanges so that those now eligible will pay less of a percentage of their income than under current law and ensure that all families purchasing on the exchange will not spend more than 8.5 percent of their income for premiums."

Clinton will continue to support Obama's initiative to support any state that covers Medicaid expansion by matching 100% of the cost for the first three years.

Clinton will ensure that the Americans who can benefit most from the Affordable Care Act, those who have no insurance but are eligible for coverage at less than $100 a month. She will commit $500 million annually to an aggressive marketing campaign aimed at these individuals to greatly decrease the number of uninsured.

As part of her longtime endeavor to ensure access to healthcare for children and mothers, regardless of immigration status, sponsored the Immigrant Children’s Health Improvement Act in the Senate, which later became law and allows immigrant children and pregnant women to obtain Medicaid and CHIP.

Clinton intends to push forward with her initiative to provide a 'public option' for insurance. She supported the public option in her 2008 campaign, and has brought that back into her platform. The public option was removed from the Affordable Care Act due to the lack of support from Democratic senators. Not one to give up easily, Clinton intends to work directly with the states to institute public options for Americans at the state level.[5]

Clinton Point by Point on Trumpcare

Completely repeal Obamacare.

Not only does Clinton not want to repeal Obamacare, stating the defense of Obamacare as the first point in her platform, she wants to expand it by as much as $40 billion over the next ten years.[6]

Modify existing law that inhibits the sale of health insurance across state lines.

Clinton is familiar enough with the health industry (her campaign donations certainly indicate this) that she knows this point of Trump's platform has little impact on the average consumer. The limitations on insurance plans across states have more to do with individual provider networks rather than state regulation. If someone in Arizona wants to buy a cheaper plan from North Carolina they'll still have to receive care in the North Carolina network, making the plan cost difference inconsequential.[7]

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

Similarly to the above, Clinton is aware that this tax deduction applies to a negligible percentage of Americans and has no real impact on costs overall.

Credit: Evan Guest - https://commons.wikimedia.org/wiki/File:Trump_with_supporters_in_Iowa,_January_2016_(2).jpg

Allow individuals to use Health Savings Accounts

Of all the points in Trump's plan, this may be the most useless. The tax-deferred Health Savings Accounts already exist- and have since 2003.

Require price transparency from all healthcare providers.

While Clinton has not expressed an interest in transparency, she has expressed interest in limiting prices through regulation. She has also expressed an interest in clearing out the FDA backlog of prescriptions waiting for approval. Releasing those from the FDA would bring a large quantity of generic and alternative medications that would increase market competition.[8]

Block-grant Medicaid to the states.

Clinton is against block-grant for Medicaid across the board.[9] She is eager to work with states to increase their Medicaid coverage, but does not trust the states. Specifically those states who have refused the 100% match money from the Federal government at the expense of their most vulnerable people. State government refusal of the match program, and therefore creating a large number of individuals who cannot afford coverage, is one of the most detrimental impacts to Obamacare. It is no surprise that those states all have Republican governors.

Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

This is, as described above, one of the points upon which Clinton and Trump nearly agree. Clinton has several plans to achieve this goal, starting with clearing the backlog of medications awaiting approval by the FDA, and increasing competition for new "specialty" medications.