Clinton Wants To Enhance Obamacare While Trump Wants To Repeal It The candidates diverge sharply on Obamacare but both Hillary Clinton and Donald Trump see opportunities to improve health care through the tax code.

Platform Check: Trump And Clinton On Health Care

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Now let's look at where the presidential candidates stand on the issues. It's time for Platform Check.


HILLARY CLINTON: Raise the national minimum wage so people have...

DONALD TRUMP: We're going to have the biggest tax cut since Ronald Reagan and...

CLINTON: We have to reform our criminal justice system so...

TRUMP: A very, very strong border.


CORNISH: We're going to be talking about the Affordable Care Act, or Obamacare as it's known. Open enrollment began this week. That means people are logging onto their computers to buy health plans for next year. About 20 million people now have health insurance because of the law.

Hillary Clinton and Donald Trump have very different opinions of it, and joining us now to explain them is NPR's health policy correspondent Alison Kodjak. Welcome to the studio.

ALISON KODJAK, BYLINE: Thanks for having me.

CORNISH: So first we should mention that this is actually a pivotal moment for Obamacare right now, right? What's going on?

KODJAK: Yeah, we're going into the fourth year of Obamacare in terms of the insurance policies being sold on the exchanges. And what's happened is several insurance companies have pulled out of the program in many markets.

So there's less choice for consumers, and prices are going up. People see this as a make-or-break year in some ways because if more people don't enroll, we may have more insurance companies pull out.

CORNISH: And of course Hillary Clinton has defended Obamacare as part of the Obama White House legacy, but she says she would change it. And at the second presidential debate, she said this.


CLINTON: You may not be able to have insurance because you can't afford it. So let's fix what's broken about it, but let's not throw it away.

CORNISH: All right, Alison, give us some details. What would Hillary Clinton do?

KODJAK: She wants to reduce the amount of money people have to pay out of pocket either by limiting that number overall or by offering tax credits that let people get money back at the end of the year if more - if a certain amount of their income is spent on health care costs.

In addition, broadly, she wants to reduce the amount of money spent on health care overall, and the first big proposal she made has to do with making sure that drug companies don't increase drug prices too much. And she would have federal authorities watch what they're doing and make sure that there's a reason for their drug price increases.

CORNISH: So is she talking about kind of tweaking what's there, or does she have bigger changes in mind?

KODJAK: Well, those are mostly the tweaks. She does have some bigger changes in mind, though. One would allow people 55 and older to buy into Medicare. Right now it's limited to people 65 and older. And that would bring many more people into the Medicare program but also ensure that younger, healthier people are the ones buying insurance on the individual market, which could lower premiums there.

In addition, she's proposed bringing back the idea of the public option, which is having the federal government directly sell insurance in the Obamacare exchanges. And that would theoretically increase competition in places where there may be only one insurance company offering plans there.

CORNISH: All right, Alison, so let's turn to Donald Trump. What has he had to say so far?

KODJAK: Well, Trump, like most Republicans, says he wants to repeal and replace Obamacare. He hasn't really completely defined what he's going to replace it with, but we can hear what he has to say about it this week.


TRUMP: Our replacement plan includes health savings accounts, a nationwide insurance market where you can purchase across state lines and letting states manage Medicaid dollars so much better.

KODJAK: So he's proposing here health savings accounts which allows people to save tax-free to pay for what their health care costs, including premiums and any other costs that they come up with after their insurance doesn't cover it.

He's also proposing allowing insurers to sell policies across state lines, which would, he says, increase competition by having more insurance companies selling insurance in different markets, and therefore it would lower premiums across the country. And he wants to make premiums tax-deductible. That means most of his policies really are done through the tax code.

CORNISH: But you - it sounds like what you were saying is he does leave it up to the individual to get their own insurance.

KODJAK: Yeah, he'll get rid of the Obamacare mandate which says you have to buy insurance or pay a tax penalty and instead allow people tools to save money in order to buy their own plan. But a lot of critics say that that wouldn't be enough for lower-income people who don't have a lot of excess cash in order to buy insurance.

CORNISH: Have people looked at these plans? Do we know what the effect of this proposal would be if it became policy?

KODJAK: Yeah, there's been one major examination of both the plans by the RAND Corporation, and what they found is essentially both plans probably will increase the deficit to some degree. They have a big range from no increase to billions of dollars up to, like, $90 billion for Trump's plan and $40 billion to Hillary's.

And then separately, there's says that Hillary Clinton's plan would reduce the number of people who don't have insurance while Donald Trump's plan would increase it by millions of people.

CORNISH: That's NPR's Alison Kodjak. Alison, thanks so much.

KODJAK: Thanks for having me.

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