By Erin Mershon, CQ Roll Call
September 23, 2016 -- The health care policy proposals of Hillary Clinton and Donald Trump would have dramatically different impacts on the uninsured rate in the United States and on out-of-pocket health care costs. But they share one trait: Both would add to the federal deficit, according to a study released Friday.
Trump's plan, which centers on repealing and replacing the Affordable Care Act, would increase the number of uninsured Americans by somewhere between 16 million and 25.1 million people, depending on which parts were enacted, and drive up out-of-pocket costs for enrollees currently benefiting from the health law. Clinton's proposals, on the other hand, would reduce the number of uninsured by between 400,000 and 9.6 million people. Her most ambitious reforms would decrease health spending for low-income consumers by as much as 33 percent.
The numbers highlight the extremes of the potential policy changes and come from The Commonwealth Fund, which supports the health law. The group relied on a RAND simulation to assess the individual impact of each presidential candidate's health care proposals.
The analysis underscores the broad range of policy proposals that have been offered ahead of the November election.
Trump's plan could cost anywhere between $0.5 billion to $41 billion, relative to current law. Clinton's on the other hand, could range between $0.7 billion and $90 billion, depending on which policies are implemented.
While both Clinton and Trump laid out ambitious agendas for their respective presidencies, political realities will almost certainly limit what they can accomplish.
"It's clear that there are two widely disparate approaches to ensuring Americans' health care coverage, access to the care they need, and protection from burdensome health care costs," said Commonwealth Fund President David Blumenthal.
Commonwealth found that the controversial public option, which would add a government-run insurance program to the exchanges, might increase the insured population by just 400,000 people—the smallest impact on the uninsured rate of any of the proposals the group examined. That option also would not dramatically affect most people's out-of-pocket spending, the researchers said.
The group examined three other Clinton proposals, all of which centered on making health insurance on the exchanges more affordable. They examined her proposals to add a cost-sharing tax credit of between $2,500 and $5,000 per family, to reduce the maximum contributions families must make toward their health insurance premiums to qualify for existing tax credits, and to eliminate the so-called "family glitch."
Clinton's tax credit proposal would have the biggest impact on both the uninsured rate and the deficit. Commonwealth found that about 9.6 million more people would gain insurance. Eliminating the family glitch and reducing the maximum premium contribution would increase the number of insured Americans by a combined total of about 2.8 million.
All four proposals would reduce out-of-pocket costs for at least some groups, though the cost-sharing tax credit would have the biggest impact on those costs. That option, however, also came with the largest price tag: $90.4 billion.
The group examined each of the proposals separately, in part because Clinton has offered a number of other health care policy ideas on issues such as drug price negotiation, Alzheimer's research, and a Medicare buy-in for younger individuals.
In their examination of Trump's proposals, the group was careful to describe their limitations. The researchers said their analysis lacked key details and noted that they had not considered some Republican proposals to replace the 2010 health law with, for example, advance refundable tax credits, none of which Trump has specifically endorsed.
Instead, the researchers modeled his proposals to fully repeal the 2010 health law, allow individuals to deduct health insurance premiums from their tax returns, convert the Medicaid and Children's Health Insurance Programs to block grants, and promote the sale of health insurance across state lines.
"Modeling health reform proposals that have not yet been turned into legislation can be challenging because of lack of specificity," they wrote in their brief. "Further, Trump would implement several other proposals that could interact with the health policies, such as changes in tax rates."