If a Republican Wins the Presidency, Will ACA Survive?


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Republican candidates Donald Trump, Sen. Ted Cruz (Texas), Sen. Marco Rubio (Fla.) and Gov. John Kasich (Ohio) unanimously promise to repeal the Affordable Care Act once in office. 

Democratic candidate Hillary Clinton would expand the ACA, while Sen. Bernie Sanders (I-Vt.) favors implementing a single-payer system.

Trump’s plan would eliminate the individual mandate, allow the sale of health insurance across state lines, make health insurance premium payments fully deductible, make tax-favored health savings accounts tax free and bequeathable, require medical price transparency, block-grant Medicaid to the states and allow the import of prescription drugs.  

Similarly, Rubio’s plan promises to allow the sale of health insurance across state lines and convert Medicaid to a state-by-state per-capita block grant.  Rubio has also proposed to create an advanceable, refundable health insurance tax credit and maintain coverage for those with pre-existing conditions through state high-risk pools. 

Cruz, who does not have a published health care plan, has indicated that he supports the sale of health insurance across state lines, tax-free health savings accounts and the end of employer-sponsored health insurance.  

Kasich’s plan proposes expanding policies currently in place in Ohio such as patient-centered primary care practices and implementation of an episode-based payment model.

Clinton’s plan proposes a public health insurance option at the state level and a family tax credit of up to $5,000 to offset health care costs in excess of 5 percent of income.  

Sanders’s plan would replace employer-sponsored health care with a universal, federally administered single-payer health care program.


Candidate stances on Medicare vary, though they all say they will protect the program.  Trump states he won’t cut Medicare, Cruz wants to raise the eligibility age and Rubio favors privatizing the program. 

Sanders’s health care platform includes the move to a single-payer “Medicare-for-all” plan while Clinton supports delivery system reform and is vocally opposed to privatization. 

For more information, see Candidates Use Broad Strokes to Paint Health-Care Policy Picture.

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