Suddenly, health care takes center stage in the final race to the presidential election, and the outcome will shape the Affordable Care Act and the coverage it provides to more than 40 million people.
In addition to reproductive rights, health care for most of the campaign has been a shadow issue. However, recent comments by former President Donald Trump and his running mate, Ohio Sen. JD Vance, about possible changes to the ACA have exposed Republicans to heightened scrutiny.
More than 1,500 doctors across the country recently released a letter asking Trump to reveal details about how he would alter the ACA, saying the information is necessary so voters can make an informed decision. The letter came from the Committee to Protect Health Care, a national advocacy group of doctors.
“It’s notable that a decade and a half after the passage of the ACA, we are still debating these fundamental questions,” said Larry Levitt, executive vice president of health policy at KFF, a nonprofit health information organization that includes KFF. HealthNews. “Democrats want to protect people with pre-existing conditions, which requires money and regulation. “Republicans have tried to reduce federal regulation, and the result is fewer protections.”
The two party proposals have starkly different goals for the ACA, a sweeping law passed during former President Barack Obama’s administration that established minimum benefit standards, made more people eligible for Medicaid and ensured that consumers with qualifying conditions pre-existing health conditions could not be denied medical coverage.
Vice President Kamala Harris, who previously backed a universal health care plan, wants to expand and strengthen the health care law, popularly known as Obamacare. She supports creating permanent temporary enhanced subsidies that reduce the cost of premiums. And he is expected to pressure Congress to extend Medicaid coverage to more people in the 10 states that have so far not expanded the program.
Trump, who repeatedly tried unsuccessfully to repeal the ACA, said in the September presidential debate that he has “concepts of a plan” to replace or change the legislation. Although that comment turned into something of a laugh because Trump had promised an alternative health insurance plan many times during his administration and never followed through, Vance later provided more details.
He said the incoming Trump administration would deregulate insurance markets, a change that some health analysts say could provide more options but erode protections for people with preexisting conditions. He appeared to adjust his position during the vice presidential debate, saying that the ACA’s protections for preexisting conditions should be maintained.
These health policy changes could advance as part of a large tax measure in 2025, Sen. Tom Cotton (R-Ark.) told NBC News. That could also open the door to changes in Medicaid. Conservatives have long tried to remake the health insurance program for low-income and disabled people from the current system, in which the federal government contributes a formula-based percentage of states’ total Medicaid costs, to one that limits federal outlays through block grants or per capita funding limits. ACA advocates say that would shift significant costs to states and force most or all states to abandon expanding the program over time.
Democrats are trying to turn the comments into a political liability for Trump, with Harris’ campaign running ads saying Trump has no health care plan to replace the ACA. Harris’ campaign also released a 43-page report, “The Trump-Vance ‘Concept’ on Health Care,” claiming that her opponents would “strip coverage from people with preexisting conditions and raise costs for millions.”
Republicans have stumbled in the past when they tried, unsuccessfully, to repeal the ACA. Instead, the law became more popular, and the risk Republicans posed to preexisting condition protections helped Democrats retake control of the House in 2018.
In a KFF survey last winter, two-thirds of the population said it is very important to maintain the legal prohibition on charging people with health problems more for health insurance or denying them coverage.
“People in this election are focused on issues that affect their family,” said Robert Blendon, professor emeritus of health policy and political analysis at Harvard. “If people think Trump will affect their own insurance, that might matter.”
Vance, in a Sept. 15 interview on NBC’s “Meet the Press,” attempted to downplay this impact.
“You want to make sure that pre-existing coverage (conditions) are covered, you want to make sure that people have access to the doctors that they need and you also want to implement some deregulatory agenda so that people can choose a health care plan that fits them well.” , he stated.
Vance went on to say that the best way to ensure everyone is covered is to promote more options and not put everyone in the same insurance risk pool.
Risk pools are essential for insurance. They refer to a group of people who share the burden of health costs.
Under the ACA, enrollees are generally in the same group regardless of their health status or pre-existing conditions. This is done to control premium costs for everyone by using the lowest costs incurred by healthy participants to control for the highest costs incurred by unhealthy participants. Separating the sickest people into their own group can lead to higher costs for people with chronic illnesses, which could put coverage out of their financial reach.
The Harris campaign has seized on the threat, stating in its recent report that “health insurers will once again discriminate based on your health or poor health.”
But some critics of the ACA believe there are ways to separate risk groups without undermining coverage.
“As expected, it has been exaggerated for political purposes,” said Theo Merkel, a former Trump aide who is now a senior fellow at the Paragon Health Institute, a right-wing organization that produces health research and policy proposals based on the market. .
Adding short-term plans to coverage options will not hurt the ACA market and will give consumers more affordable options, said Merkel, who is also a senior fellow at the Manhattan Institute. The Trump administration increased the maximum duration of these plans and then Biden reduced it to four months.
People eligible for subsidies would likely purchase comprehensive ACA plans because, with financial aid, they would be affordable. Therefore, the ACA market and its protections for pre-existing conditions would continue to operate, Merkel said. But offering short-term plans would also provide a more affordable option for people who don’t qualify for subsidies and who would be more likely to buy the ineligible plans.
He also said that in states that allowed people to buy non-ACA-compliant plans outside of the exchange, the exchanges performed better than in states that prohibited it. Another option, Merkel said, is a reinsurance program similar to the one operating in Alaska. Under the plan, the state reimburses insurers for covering very expensive health claims, helping to keep premiums affordable.
But ACA advocates say that separating sick and healthy people into different insurance risk groups will make health coverage unaffordable for people with chronic illnesses, and that allowing people to buy short-term health plans for longer periods will be counterproductive.
“It leaves people uninsured when they get sick,” said Leslie Dach, CEO of Protect Our Care, which advocates for the health law. “There is no reason to do this. It is excessive and makes no economic sense. “They will hide behind saying ‘we are improving it,’ but that is all false.”
Meanwhile, Harris wants to preserve the temporary expanded subsidies that have helped more people get lower-priced health coverage under the ACA. These expanded subsidies that help about 20 million people are set to expire at the end of 2025, setting the stage for a pitched battle in Congress between Republicans who want to let them run out and Democrats who say they should be made permanent.
In September, Democrats introduced a bill to make them permanent. One challenge: The Congressional Budget Office estimated that doing so would increase the federal deficit by more than $330 billion over 10 years.
In the end, the ability of either candidate to significantly grow or change the ACA rests with Congress. Polls suggest Republicans are in a good position to take control of the Senate, while the outcome in the House is more up in the air. However, the margins are likely to be tight. In any case, many initiatives, such as expanding or restricting short-term health plans, can also move forward with executive orders and regulations, as both Trump and Biden have done.
