Voters are already heading to the ballot box in droves to choose between President Trump and former Vice President Joe Biden, and the issue of health care has become a key issue.
At the core of the candidate’s divergence on health care policy is the Affordable Care Act (ACA), otherwise known as Obamacare. President Trump wants to completely repeal and replace the health care law, while Biden prefers to build upon and refine the existing law.
Here’s a look at the details of the individual policies:
Affordable Care Act
President Trump has made clear that he wants to repeal the ACA but has yet to offer a comprehensive plan should the ACA be overturned by the Supreme Court and millions of Americans lose their health insurance.
“What the president put out was well short of a plan,” Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, told Yahoo Finance. “On the highest profile issue of protecting people with pre-existing conditions, the president promised to continue those protections if the ACA is overturned. But he’s offered no details about how he would do that.”
And despite Trump’s vow to use an executive order to maintain protections for millions of Americans pre-existing conditions, experts are skeptical.
“It is the employer that is actually the big insurer,” Wendell Potter, a former executive for Cigna, told Yahoo Finance. “So an executive order can’t touch all that, can’t require companies to do something.”
Prior to the ACA, Potter said, “it was a “horrible, horrible world” in which 15 million people in the country didn’t have health insurance. As the leader of corporate communications for Cigna at the time, Potter had a message to convey.
“I was supposed to make people believe that wasn’t such a big problem, that a lot of people were uninsured by choice,” he said. “I was expected to leave out this very important point: That many of those people were not able to buy insurance at any price because they had a preexisting condition.”
Medicaid comes with a high price tag, accounting for 16% of total national health expenditures in 2018 at $597.4 billion.
The Supreme Court ruled that it was unconstitutional for states to be forced into expanding Medicaid, declaring that it should be left up to the states to decide. Currently, there are still 12 states that have not adopted the Medicaid expansion. The rates of uninsurance in those states are significantly higher than the rest of the nation.
The Trump administration announced plans to allow states to begin putting a cap on Medicaid spending. Seema Verma, the Trump-appointed administrator of the Centers for Medicare and Medicaid Services (CMS), also began allowing states to require people on Medicaid to work or train for a job (applicable to those under 65 years old who aren’t pregnant or don’t qualify for Medicaid based on a disability).
This led to 17,000 people losing coverage in Arkansas while in New Hampshire, almost 17,000 people were about to lose coverage until the policy was put on hold.
“Government has a solemn responsibility to provide for the most vulnerable among us,” Verma said. “Part and parcel of that responsibility is making sure the Medicaid program is sustainable.”
Biden has said he wants to expand coverage to low-income Americans through Medicaid. For people in non-expansion states that would otherwise qualify for Medicaid, they would automatically be enrolled into the program through Biden’s plan.
As for the Medicaid “glitch,” which has left an estimated 4.8 million people unable to get Medicaid and left in the “coverage gap,” Biden’s plan would eliminate the income cap (400% of the federal poverty line) that is required to obtain premium subsidies. And, according to the plan, households would pay no more than 8.5% of their earnings into their health care plans.
Christen Linke Young, a fellow at the USC Brookings-Schaffer Initiative, called Medicaid an “extremely important component of our coverage landscape.”
“It’s not that the ACA changed how this group of people gets health insurance,” Young told Yahoo Finance. “It enabled them to get health insurance at all in the 39 states that expanded.”
Biden’s plan is to lower the Medicare eligibility age from 65 to 60, but this could cost up to an estimated $200 billion over a decade, according to the Committee for a Responsible Federal Budget. He also wants Medicare to include coverage for dental, vision, and hearing.
Bill Hoagland, senior vice president at the Bipartisan Policy Center, took issue with lowering the age of eligibility given the costs.
“The Medicare HI trust funds will exhaust we think in 2023,” he told Yahoo Finance. “When you reduce that age of eligibility for Medicare, you will speed up the exhaustion. If that were actually to come to pass, that would need a 17% reduction in Medicare payments.”
Trump has vowed to protect Medicare. However, his proposed 2021 budget cut approximately $450 billion in Medicare spending over a decade.
Reproductive health care
Trump, who has a large support base of evangelical Christians, has stated that he wants Roe v. Wade overturned. Upon nominating Amy Coney Barrett to the Supreme Court, he said it could be a possibility.
Trump has also prohibited federal funding for any clinics that provide or refer for abortion, including Planned Parenthoods. His administration has allowed employers to withhold coverage for contraceptives based on moral or religious grounds, thanks to a Supreme Court ruling. He has also reversed antidiscrimination provisions for LGBTQ patients and those who have terminated a pregnancy.
Biden is pro-choice and in support of Roe v. Wade, pledging to make it “the law of the land.” The former vice president said he would nominate judges to the Supreme Court He has vowed to reverse Trump’s actions regarding federal funding, contraceptive coverage, and antidiscrimination rules.
Mental health care, opioids
Both candidates have released suicide prevention plans with focuses on veterans. Trump’s includes a budget increase for the VA, while Biden has proposed expanding mental health programs for veterans both inside and outside the VA. Biden’s plan also includes programs for reducing suicide among LGBTQ youth.
Biden released a five-point plan to address the crisis which includes curbing overprescribing, reforming the criminal justice system, stemming the flow of illicit drugs into the U.S., holding pharmaceutical companies and executives accountable for their roles, and expanding treatment, prevention, and recovery services through a $125 billion federal investment.
Prescription drug prices
Biden’s plan would repeal the “outrageous exception” that allows drug corporations to avoid negotiating with Medicare over drug prices. He would also limit launch prices for drugs that have no competition and limit price increases for brand, biotech, and “abusively priced” generic drugs to inflation.
His plan would also allow consumers to buy prescription drugs from other countries, improve the supply of generic drugs, and eliminate the tax breaks for pharmaceutical companies’ ad spending.
Meanwhile, back in September, Trump signed an executive order that expanded the drugs covered in his “most-favored-nation price” to include Medicare Parts B and D.
“It is unacceptable that Americans pay more for the exact same drugs, often made in the exact same places,” the order said.
Biden’s plan would prohibit health care providers from charging out-of-network rates when the patient has no control over who their provider is. For example, when someone is hospitalized and needs surgery, the anesthesiologist might be out of network but the surgeon is not. The patient would be hit with the full medical bill for the anesthesiology services.
End surprise billing as well. Through an executive order, the White House directed the Department of Health and Human Services (HHS) to work with Congress to find a solution to ending surprise billing. If one isn’t reached by the Dec. 31 deadline, HHS “shall take administrative action” to prevent patients from receiving bills for unexpected out-of-pocket expenses.
Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells.