News/ Health

Donald Trump and Hillary Clinton's plans for health care and Medicare

Health care is among the top four issues for registered voters in the upcoming presidential election, according to Pew Research poll results. Seventy-four percent said it was "very important" to their vote.

Here is what Donald Trump and Hillary Clinton have said or written about their plans for health care and Medicare:

The Affordable Care Act

Donald Trump: He has called repeatedly for the repeal of The Affordable Care Act (aka Obamacare). But Trump has also said that he supports its primary tenet: the provision that all Americans be required to buy health insurance. On a CNN Town Hall Forum with Anderson Cooper in February, Trump said, "I like the mandate... I don't want people dying on the streets."

However, in his statement, "Healthcare Reform to Make America Great Again, published on his campaign website, Trump writes that he will ask Congress to repeal Obamacare "on day one" of his administration - and that elected leaders must eliminate the individual mandate. ďNo person should be required to buy insurance unless he or she wants to,Ē he says.

An April 8 article in The New York Times quoted James C. Capretta, a senior fellow at the conservative Ethics and Public Policy Center, saying Trump underestimates how engrained the Affordable Care Act now is. "It took a herculean political effort to put in place the Affordable Care Act," Capretta said. Dismantling it and going in another direction "even incrementally, would take an equally herculean effort, with clear direction and a clear vision of what would come next. I just donít see that in Trump's vague plans to repeal the law and replace it with something else."

Hillary Clinton: She has praised Obamacare and pledged to not only keep the law in place but to expand it.

"The Affordable Care Act was a critically important step toward the goal of universal health care, offering coverage to 20 million more Americans, and ensuring all Americans will never be denied coverage on account of pre-existing conditions or their gender," the Clinton website says.

But there is more to do, Clinton says, including working with governors to expand Medicaid in states that have refused to do so and expanding access to affordable health care to undocumented immigrants.

Clinton also supports the creation of a "public option" within Obamacare, a government-run health insurance plan that would compete against private insurers.

Voters were more likely to say they trust Democrats (49%) than Republicans (38%) to do a "better job dealing with the future" of Obamacare, according to a July health poll by the Kaiser Family Foundation.

Health Care Costs

Donald Trump: He says on his site that he wants to change current law to allow the sale of health insurance across state lines. The increased competition will allow health care costs to go down, Trump says.

Trump also blames illegal immigrants for high costs. "Providing healthcare to illegal immigrants costs us some $11 billion annually," he writes. "If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments."

Trump also favors allowing individuals to "fully deduct" health insurance premiums from their taxes. Today, you can only write off health insurance premiums to the extent that they and other out-of-pocket health costs exceed 10% of your adjusted gross income (7.5% if youíre 65 or older) or if you are self-employed.

Hillary Clinton: According to Clinton's website, she would "build on the Affordable Care Act by requiring insurers and employers to provide up to three sick visits to a doctor per year without needing to meet the planís deductible first."

She also calls for a "new, progressive refundable tax credit of up to $5,000 per family for excessive out-of-pocket [health care] costs." That's aimed at middle-class families who may not be able to benefit from current medical expense tax deductions. The lost tax revenue from the credit would be replaced for "by demanding rebates from drug manufacturers and asking the most fortunate to pay their fair share [of taxes]," Clinton says.

Both candidates have called for more transparency on health care costs.

Prescription Drug Costs

Total U.S. prescription drug sales in 2015 were more than $419.4 billion - 11.7% higher than in 2014, according to research published in May in the American Journal of Health-System Pharmacy. You don't have to tell that to American consumers, especially older adults, who are dealing with rising prescription drug costs. A 2015 Kaiser Health Tracking Poll found that three-quarters of Americans believe prescription costs are unreasonable.

Donald Trump: He stunned Republicans by calling in January for Medicare to negotiate prescription drug prices, joining Clinton and Bernie Sanders in that proposal. Trump said it hasn't been done thus far because politicians are beholden to pharmaceutical industry donations. But with his negotiation skills, he could accomplish it, he said, claiming this change would save billions of dollars. (Current law doesn't allow Medicare to negotiate with drug companies.)

Like Clinton, Trump has also called for a change in U.S. law to allow importation of drugs from foreign countries, including Canada, to save Americans money. One big problem with that idea: Critics say there is no way to guarantee that the drugs arenít counterfeit or contaminated, as I wrote in a recent Next Avenue article.

Hillary Clinton: The area of Clinton's site dedicated to drug prices says: "Hillary Clinton believes we need to promote competition and leverage our nation's bargaining power to lower drug costs on behalf of Americans." That includes allowing Medicare to negotiate on drug prices on behalf of its beneficiaries.

The site also says: "Her plan will demand a stop to excessive profiteering and marketing by denying tax breaks for direct-to-consumer advertising and demanding that drug companies invest in R&D in exchange for taxpayer support - rather than marketing or excessive profits."

Clinton, the site notes, will also "encourage competition to get more generics on the market" and "cap what insurers can charge consumers in out-of-pocket costs, putting money back in the family wallet."

And as mentioned above, she has proposed allowing the importation of drugs from other countries, "with careful protections for safety and quality."

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