(Reuters) – Healthcare was already a top concern among U.S. voters even before the coronavirus pandemic killed tens of thousands of Americans and eliminated millions of jobs.
The crisis is likely to shine an even brighter spotlight on the vast differences on healthcare policy between Republican President Donald Trump and presumptive Democratic nominee Joe Biden ahead of November’s election.
Here is a look at how the two rivals clash on key issues:
After years of failed attempts by Republican lawmakers to repeal the Affordable Care Act, popularly known as Obamacare, Trump has turned to other tools to undermine the sweeping healthcare law: executive power and the courts.
The Justice Department is backing a lawsuit brought by several Republican-led states seeking to overturn the entire ACA, a case the U.S. Supreme Court is expected to hear sometime this fall. The Trump administration has not proposed a comprehensive replacement, despite Trump’s vow to deliver a better, less-costly healthcare system.
The Republican-backed 2017 tax bill eliminated the ACA’s individual mandate, which required most people to maintain insurance or face a penalty. The result was increased premiums, according to experts.
In addition, Trump has used executive power to boost short-term plans, which are exempt from the ACA’s requirement to cover basic benefits and guarantee coverage for people with pre-existing conditions.
Under former President Barack Obama, those plans could only be used temporarily for three months. Trump has increased that period to three years, a move opposed by many patient advocates, hospital groups and health insurers.
The Trump administration also cut funding for staff and advertising intended to help people navigate the ACA marketplaces, where individuals can purchase private insurance, often with the help of government subsidies.
Biden has vowed to bolster the law, which passed during his first term as Obama’s vice president. His own healthcare plan would cost $750 billion over 10 years and would be financed by increasing taxes on the wealthy, according to his campaign.
Unlike his former rival for the Democratic nomination, Senator Bernie Sanders, Biden does not support a single-payer system like Medicare for All.
Instead, Biden’s plan calls for a Medicare-like public option that would serve as an alternative, not a replacement, for private insurance. The public option would be available for small businesses and individuals who do not have, cannot afford or do not like their employer-based coverage.
In addition, several million people who are uninsured because they live in one of the 14 states that have refused to expand Medicaid – which provides coverage for low-income Americans – under the ACA would automatically be enrolled in the public option. He also has proposed expanding the subsidies available on the ACA marketplaces and capping cost increases.
Trump’s rhetoric has been more hawkish on prescription drug prices than that of most Republicans, but his results have been uneven.
The administration had proposed basing the price of some Medicare drugs on the cost in foreign countries, where medicines tend to be cheaper, but the effort has stalled. Another proposal, to require drug companies to disclose list prices in television advertising, was blocked by a federal court.
Biden supports a bill approved by the Democratic-led House of Representatives last year that would allow Medicare to negotiate drug prices, as private insurers do.
Republicans, backed by the pharmaceutical industry, have argued it would force drug makers to spend less on research and development, and the Trump administration has said it would veto the bill.
Both Biden and Trump support some form of importing prescription drugs from foreign countries to lower costs, though some experts have questioned whether doing so is feasible.
In April, Biden proposed lowering the Medicare eligibility age from 65 to 60, a move to appeal to liberal voters. Such a change would potentially extend Medicare to some 20 million more Americans.
Trump has proposed several budgets that include cuts to Medicare and Medicaid spending. The Medicare reductions would not affect benefits but would instead change how providers are paid, according to Tricia Neuman, a Medicare expert at the Kaiser Family Foundation.
The administration has supported imposing work requirements and other limitations on Medicaid eligibility, as well as installing caps on Medicaid spending growth and converting Medicaid to block grants – all moves that experts say would result in fewer people covered.
The impending insolvency of the Medicare trust fund, which was projected for 2026 even before the economy cratered, casts a shadow over all of these proposals.
“Whichever president comes in will face some really difficult decisions, as will Congress,” Neuman said.
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