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The 2016 Presidential Candidates and Health Care Reform: The Future of the ACA


A key aspect of the current presidential election dialogue is health care and the future of the Affordable Care Act (ACA), or Obamacare. The law directly impacts businesses, and proposed changes to the law stand to do so as well. Let us look at an overview of where each candidate would like to take the country as it relates to health care reform.




Donald Trump’s general position is to repeal and replace the ACA. According to his campaign website on day one of his administration he would ask Congress to deliver a full repeal of Obamacare (ACA). His replacement policy framework includes the sale of insurance across state lines, allowing insurance to be fully deducted on individual tax returns, easing the ability of individuals to purchase health savings accounts and turning Medicaid into block grants for the states.

To repeal the ACA  and implement a replacement plan, the GOP would need to not only take the White House, but also gain a filibuster proof majority in the Senate, something which is likely unobtainable for the Republicans in this election. Additionally, healthcare markets are intricate, making the policy hurdle of developing a replacement plan considerable. It is more likely that they will need to work to pass amendments to the law where they can, and influence the trajectory through regulators. However, it should be pointed out that the powers bestowed upon the regulators are still limited by the current law.

Hillary Clinton’s general position is to defend and strengthen the ACA. According to her campaign website she would further expand the ACA by bringing back the public option (proposed in the initial drafting of the law) by creating a government health insurance program to compete with private plans, allow those 55+ to buy into Medicare, bring down out of pocket copays/deductibles, incentivize states to expand Medicaid and expand access to individuals regardless of immigration status.

The public option has garnered a lot of press for the Clinton campaign. Still, to implement a public option, Democrats would need to not only take the presidency, but also establish significant majorities in both the House and Senate, something that is likely not possible this election. Clinton would also presumably need to address challenges in the ACA which are getting more attention, such as the difficulties in drawing younger, healthier individuals to purchase coverage and the resulting premium increases and carrier departures from the exchanges. Even her husband, former president Bill Clinton, has acknowledged these issues.

It should be noted that for both candidates, the bulk of their policy wish lists would have federal budget implications: largely absent from the discussion is the mechanism utilized to pay for them.

Given the significant focus small businesses have on health care and associated costs, it will be important to track developments. In the short term, employers should ensure compliance with current ACA obligations.

To see more on the candidates stated stance on health care reform visit their respective websites:




About the Author

Laurie Savage is a Compliance Analyst II at Paychex, Inc.


This website contains articles posted for informational and educational value. Paychex is not responsible for information contained within any of these materials. Any opinions expressed within materials are not necessarily the opinion of, or supported by, Paychex. The information in these materials should not be considered legal or accounting advice, and it should not substitute for legal, accounting, and other professional advice where the facts and circumstances warrant.
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