What does the election mean for the future of health care?
Contributor: Buddy Robinson
The issue of health care remains a top priority of voters, because it continues to get less and less affordable. At the same time, restrictions on what's covered and which doctors you can see gets worse and worse. The COVID pandemic has made the problems in health care access and cost all the more alarming.
This is a huge topic for the November election. If Trump gets re-elected, he and the Republicans in Congress won't just fail to reverse the trend in greater cost and restrictions. They'll accelerate it.
There are a number of forms of health care coverage for Americans. The fate of each of these rests on the outcome of the elections. Let us count the ways:
This is the federal program for people 65 and older and many disabled people. Trump and the Republicans want to put more and more of Medicare in the hands of insurance companies, which wastes vast amounts of taxpayer money, and lets those companies control who you can see, and whether specific treatments get paid for.
Their big goal is to turn Medicare into a voucher system, where the government gives you a set amount per month to help you buy an insurance policy. The insurance companies, not the government, will then decide what the policy will cover. The government voucher won't rise with medical inflation, and so it will pay for less and less each year. The average senior will pay $12,000 out of pocket annually, instead of $6,000.
If they don't win their voucher system, their next best bet is to greatly increase the use of the Medicare Advantage program – in which insurance companies already control the Medicare of those who choose it. It's a voucher system on training wheels.
This is the federal system for low income people of all ages. You might think that this mostly goes for healthcare for non-senior adults and kids, but you'd be wrong. About two-thirds of all Medicaid money pays for long term care, especially nursing homes. So, it is critical for all the seniors who end up in nursing homes. It's paid for by roughly half federal money and half state money.
Trump and the Republicans want to turn it into a flat grant system. That means the federal government gives the state a set amount per year in total, or a set amount per enrollee. It will rise according to overall inflation, but not fast enough to cover medical inflation.
So over time, the federal share covers a smaller and smaller portion of the overall cost. That forces states to either jack up taxes to cover the loss, or start reducing Medicaid benefits and/or eligibility.
OBAMACARE (aka Affordable Care Act)
Most people should be aware that the Republicans want to do away with ObamaCare, and that Trump has gone to court to try to eliminate it. If that were to happen, tens of millions of people would be hurt.
Part of ObamaCare was an increase in income eligibility for Medicaid, which most states took advantage of. Those newer enrollees would be thrown off the roles. The other big program in ObamaCare are the subsidies to help other people afford to buy insurance policies. If those subsidies disappear, a whole other set of millions wouldn't be able to afford good coverage.
ObamaCare also stopped insurance companies' ability to deny coverage for pre-existing conditions, and it made some improvements to Medicare as well. Those provisions would be lost. Trump and the Republicans are flat-out lying when they say they will protect pre-existing conditions. They intend to let insurance companies decide.
Biden and the Democrats, in contrast, would push for an improvement of Obamacare, in the form of a Public Option. That would allow all Americans to buy coverage at a more affordable price.
ObamaCare also did away with “junk” policies, which have low premiums, but hardly any actual significant coverage. Trump re-instated these, by executive action. His action needs to be reversed.
EMPLOYEE HEALTH COVERAGE
What about the majority of Americans, who get their health coverage through their employer? For some, the ObamaCare subsidy program gives a better deal than what their employer offers, and so they are at risk of losing that if Trump and the Republicans get their way.
For many more people, their employer coverage is the best deal available to them now. However, that deal slowly gets worse every year: Higher premiums, deductibles, and co-pays. More and more restriction on which doctors you can see.
They can expect to see their health care continue to get less and less affordable every year. The only fix for that is a very big one – a universal public health care system (such as improved Medicare for all), which everyone would get regardless of their work status or situation.
Until we can make that happen, the overwhelming immediate need is to block Trump and the Republicans from making everyone's health care much worse.
*Threats to the Safety Net