Analyses find Clinton, Trump health plans both add to federal deficit

It is no surprise that the drastically different approaches the two presidential candidates have to the Affordable Care Act could result in a change in how many people have health coverage, but a new analysis shows that Hillary Clinton's plans would likely reduce out-of-pocket costs while Donald Trump's would increase these costs dramatically while adding to the federal deficit.

A report from the Commonwealth Fund analyzed Clinton's plan to introduce a cost-sharing tax credit for out-of-pocket spending, reduce the maximum premium contribution individuals must make in ACA plans, eliminate the “family glitch” and introduce a public option to the marketplaces.

The family glitch in the ACA prevents families from receiving subsidies for marketplace coverage even if the employer-based insurance they are offered is prohibitively expensive.

Her plan would result in 9 million more insured and would also reduce out-of-pocket costs for some on the exchanges by about 33%. It would add about $90 billion to the deficit.

Trump's plan of repealing the ACA, converting Medicaid to block grants and allowing the sale of health insurance across state lines would likely mean more than 20 million more uninsured and raise out-of-pocket costs to about $5,000 more per enrollee. It increases the federal deficit by as much as $41 billion.

Sara Collins, a vice president at the Commonwealth Fund, said the analysts at RAND Health had to make some assumptions about both candidates' plans because they lack detail. The campaigns each responded to questions about their plans. The Trump campaign directed the foundation to its website.

The report shows how dramatically different the proposals for healthcare are in the presidential race and the immediate impact each would have, Collins said.

“They enable the public and policymakers to better understand what the effects of the proposals would be,” she said. “I think they provide the ability to get the sense of what direction these proposals would send the healthcare system.”

Repealing the ACA would also mean eliminating its provisions that generate revenue, such as taxes on health plans and medical devices, thus adding to the deficit. Out-of-pocket costs would increase because of a reduction in cost-sharing, smaller credits toward premium costs and a lack of requirements for robust plans.

A full repeal of the ACA would be difficult even in a Trump administration, however. Democrats would filibuster such efforts even if they don't gain control of either chamber in Congress.