Donald Trump's Health Care Reform Proposals

Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit

Published in: The Commonwealth Fund, v. 32, Sep. 2016

Posted on RAND.org on November 04, 2016

by Evan Saltzman, Christine Eibner

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ISSUE: Republican presidential candidate Donald Trump has proposed to repeal the Affordable Care Act (ACA) and replace it with a proposal titled "Healthcare Reform to Make America Great Again." Proposed reforms include allowing individuals to deduct the full amount of premiums for individual health plans from their federal tax returns, providing block grants to finance state Medicaid programs, and allowing insurers to sell insurance across state lines. GOAL: To assess how each of these reforms, when implemented individually, would affect insurance coverage, consumer out-of-pocket spending on health care, and the federal deficit in 2018. METHODS: RAND's COMPARE microsimulation model. KEY FINDINGS AND CONCLUSIONS: The policies would increase the number of uninsured individuals by 16 million to 25 million relative to the ACA. Coverage losses disproportionately affect low-income individuals and those in poor health. Enrollees with individual market insurance would face higher out-of-pocket spending than under current law. Because the proposed reforms do not replace the ACA's financing mechanisms, they would increase the federal deficit by $0.5 billion to $41 billion.

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