In the 2020 Election Americans’ Health Insurance is at great Stake

COVID-19 will surely make health and health insurance a prime issue in voters’ minds, so health care issues will get plenty of attention from both Republican and Democratic sides in the 2020 presidential election. Millions of Americans are on the verge of gaining or losing the health insurance coverage in this presidential election. A Supreme Court ruling is expected in the next year, and an unfavorable ruling might lead to millions of low-income and middle-class people losing health coverage amidst the pandemic.

The Donald Trump administration is urging the court to invalidate most or all of the Affordable Care Act, and if this happens then millions will lose health coverage. The Trump administration has revealed its plan for people with preexisting conditions that in reality is no plan at all and instead it is a plea to trust that Trump will restore healthcare protections to people. However, in reality, throughout his first term, he made effort to roll the ACA.

There is also a chance that the Supreme Court may reject the proposal of repealing the ACA, and if Joe Biden wins the election, then he may mandate to expand health coverage to millions of more Americans. He might for the first time create a government health insurance plan available to middle-class, working Americans, which will be an alternative to the private health plans offered by their employer. Residents of the states that have not expanded Medicaid may get enrolled in that new government program, thus expanding the coverage to millions of people who were earlier denied.

Joe Biden is determined to complete the ACA mission, which aimed to make universal health coverage within the reach of every person. Trump’s new Supreme Court nominee is considered as a threat to the ACA and its popular provisions. In the 2018 midterms, Democrats have criticized Republicans for repealing the health care law that won the House majority on the strength of that argument. In the November election, voters of America will decide upon the candidate they want to preside over. Trump doesn’t have an alternative plan if the Supreme Court ends health coverage for 20 million people.

The President has made it clear that he wants to get rid of the Affordable Care Act, and he has been governing on that. Biden in his first presidential debate mentioned that Trump is trying to get rid of the ACA that will strip 20 million people from having health insurance. The U.S. healthcare future has never been so disparate, because, in one of the extreme scenarios, 20 million people may lose health insurance while in the other scenario, 25 million people may gain coverage.

Trump Doesn’t Have a Plan If ACA is Invalidated

Trump has appointed three justices to hear the case and a decision is likely to come in the spring of 2021, and if the three justices side with the arch-conservatives to overturn the law, then more than 12 million people who obtained coverage through Medicaid expansion could lose the coverage along with the 11.4 million people who obtained coverage from private insurers because they relied on federal subsidies that would also be eliminated. Even the preexisting conditions protections will be wiped off, and the U.S. healthcare sector has to start over all again as if a decade of health reform has not taken place.

Though the Trump administration is promising something better and cheaper than ACA, but the White House has given no evidence that such a plan exists. Trump for weeks has been promising about a forthcoming health care plan and  recently his administration convened a call with reporters to unveil some health plan news but the details were not substantial. He needs to sign an executive order that people with a preexisting condition would be protected.

If the Affordable Care Act has been repealed then health insurers would be free to deny coverage to people with a pre-existing condition or to charge higher premiums from people because of their medical history. It has been exposed that currently, no consensus exists within the party to protect people with pre-existing conditions. Protecting people would require government spending as well as regulations for insurers, both of which differ from the GOP’s stated ideology.

Conservatives are comfortable with reconstituting ACA policies like tax subsidies, and guaranteed issue with tweaks, as they believe that this would make premiums cheaper. However, others, including the Trump administration in its proposed federal budget still support a framework, which is similar to the Graham-Cassidy bill of 2017. According to which the government would take the money appropriated by Obamacare and would convert the money into block grants so that states can spend according to their requirements. However, as per the Congressional Budget Office estimates millions of Americans would lose coverage. Both Democratic and Republican are proposing cuts to Medicaid so it is a possibility in the future.

There is an enormous pressure to prevent millions of people from losing coverage and the government needs to act but still the White House has no official plan. With only a month left to the election, Trump is not adept at passing major legislation through Congress. Thus, if the court strikes down the ACA, and with no alternative plan prepared, the law will be lapse without anything to replace it.

The uninsured rate in the U.S. was already high under Trump, especially after he undermined the ACA’s private markets. Besides, even COVID-19 has led to several million people losing the coverage. The losses would be further aggravated, as up to 20 million are expected to become uninsured with no guarantee of an alternative.

Joe Biden’s Plan if becomes Reality may Cover 25 Million People

If the Court strikes down the ACA, then Joe Biden will have an opportunity to reshape American healthcare. However, even if the law is upheld Biden can proactively push another health reform bill. Some senior Democrats are thinking of ways to control the White House and find a response to COVID-19, which tackles several weak spots exposed by the pandemic. Providing coverage to around 30 million uninsured Americans will be a hit legislative agenda.

Passing a major health care bill will be a challenge even for the Biden, and Democrats will have to make some big decisions, starting from passing a bill through the Senate. The Democrats will have to go through some delicate discussions on issues like the use of budget reconciliation with the limit placed on spending, whether to eliminate the filibuster and pass the  bill they come up through majority.

Democrats assuming that their party sweep in the election think that their smart move will keep the pressure on Republicans, and their passed legislation will be overwhelmingly popular with the masses and they will dare Republicans to oppose it. However, they should try to establish a public option, which is strongly opposed by the healthcare industry and they will spend millions to turn public options against. Instead, Democrats should expand the existing ACA subsidies for private insurances.  It is expected that Democrats may be able to create a public option without risking voter backlashes.

Democrats can be pushed to pass a public option next year by the Biden, as currently, he is proposing that the 2 million people lack coverage because their state has not expanded Medicaid. 12 million people currently having employer-sponsored insurance may find a public option to be a cheaper alternative, as per the Kaiser Family Foundation estimates. Biden is also in favor of expanding the premium tax subsidies so they may pay for a more generous plan and more people would qualify for such a plan. Even people who are not eligible for the government assistance program could find a premium price drop by half or even more.

According to the Biden campaign’s estimates, 97% of Americans are expected to have a health plan under his plan. A program similar to Biden’s proposal was modeled by the Urban Institute that discovered that all legal U.S. residents would have coverage and around 6.6 unauthorized immigrants may remain uninsured. It has been estimated that around 20% of 30 million uninsured Americans are not living lawfully in the country. This means that Biden’s plan will offer coverage to around 24 million people if Urban’s projections are correct.

Thus, depending on who sits in the White House on coming January 20, 2021, 20 million could either lose their health insurance coverage or 25 million people could gain health insurance coverage.

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