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  • Nisha Kassam

The Future of Healthcare in America

Between presidents Barack Obama and Donald Trump, America’s most popular health insurance programs have faced dramatic alterations over recent years. With Biden’s inauguration approaching, many are wondering how the president plans to ensure health care coverage amid the COVID-19 pandemic.

Medicare funding has been dwindling, especially the budget allotted for hospitalizations. The funds will now run out years before it was expected to. The Supreme Court has been hearing arguments to overturn the Affordable Care Act, which has provisions that help Medicare beneficiaries. The risk of losing insurance is a major concern for many Americans, especially low-income and elderly Americans, during our current health crisis.

On the first day of Trump’s presidency in 2017, he imposed an executive order to obstruct much of the Affordable Care Act, known as Obamacare. Though this was an ongoing effort, Trump and Congress were unsuccessful in their attempts to have the ACA repealed.

The ACA provides health insurance to those who have pre-existing health conditions or can’t afford it otherwise. With pre-existing conditions, which can be anything from acne treatments to cancer, it becomes harder to find coverage or may cost higher premiums.

Supporting those with pre-existing conditions was the most popular provision, which is why Trump repeatedly promised to keep this population insured. However, no definitive plan was made. Trump signed an executive order declaring it was “the policy of the United States” that people with pre-existing conditions should be able to obtain insurance coverage.

Nevertheless, there was no framework as to how it would be provided. This was already a law put in place by the Affordable Care Act. Many Republicans in Congress attempted to have it repealed, but failed to do so. It is now being challenged for the third time, but this attempt will likely not be the charm.

If the ACA is overturned, 23 million people could lose coverage. This could also harm Medicare and Medicaid. Under Medicare, preventative care, like check-ups, is free. If the ACA is overturned, preventative care will become costly, as will the price of prescription drugs.

This is known as the coverage gap: patients previously had to pay out of pocket, but the ACA helped diminish it. Repealing the law would eliminate a 0.9% tax for high-income clients, which goes into the Medicare fund for lower income individuals.

Under ACA, 12 million people became eligible for Medicaid, but its repeal could result in an additional 15 million people losing coverage as well, 3 million of them children. The law also prevents states from paying more than 10% of Medicaid costs — the federal government picks up the rest of the tab.

If repealed, states will have to cover the other 90%, which totaled $66 billion in 2019. Most states would not be able to handle the costs, which would result in loss of coverage. Patients rely on Medicaid for anything ranging from check-ups to addiction treatment. In fact, 800,000 people rely on this plan for treatments.

Had Trump been re-elected, his budget proposed a $1.9-trillion cut in safety net programs. This includes reduced funds for social security benefits, such as lower funds for retirement programs and disability insurance. Biden, meanwhile, has made health care a priority amid the pandemic.

He aims to remove “work requirements,” which the Trump administration created.

Trump’s new addition to Medicaid allowed states to add a mandatory work requirement to those enrolled, making it harder for low-income families to maintain their coverage. This employment requirement is being challenged by two states.

The Biden administration has also showed support on reinstating a law, which the Trump administration removed, that prevents states from withholding Medicaid funds from providers that also offer abortions, like Planned Parenthood. However, Medicaid provides very limited funding for abortions, only covering it in events of rape, incest or when the woman’s life is in danger.

Biden’s plan on health care for the LGBTQ+ community also sharply differs from Trump’s. Biden plans on expanding funding for mental health services for the LGBTQ+ community and will automatically enroll low-income members if they live in an area where Medicaid was not expanded.

The Trump administration previously attempted to remove safeguards for the transgender community in the health care system. However, the repeal request was blocked because it contradicted the precedent of a previous Supreme Court case.

Here are some of the main takeaways from Biden's proposed plans for Medicare and Medicaid:

Biden plans to automatically enroll uninsured low-income Americans either in the public option or in Medicaid, depending on whether their states expanded Medicaid to those making less than 138% of the poverty level. The public option would be federally-provided insurance under the ACA and would offer low to no premium payments.

Secondly, he plans to lower the age requirement of Medicare form 65 to 60, and add vision, hearing and dental care to coverage plans, which is currently not included unless added separately.

Medicare is not a free program. Users must pay into the program for 10 years, and then pay premiums and deductibles for outpatient services. The more you earn, the more you pay.

Biden’s plan is specifically aimed at the older generation, who may not be able afford health insurance, are unemployed, or unable to obtain a job — “[the plan] reflects the reality that, even after the current crisis ends, older Americans are likely to find it difficult to secure jobs."

23 million more people could now be covered, but hospitals are not happy about this. Other private companies pay much more back, while Medicare reimbursements are only half of what these other employer or commercial plans would have to pay.

Another major obstacle for Americans is the hefty price of medications. Biden plans to allow Medicare to negotiate prices on pharmaceutical drugs, which is currently prohibited, and allow these drugs to be bought from other countries. Furthermore, he plans on limiting launch prices of pharmaceutical drugs that have no competition.

The idea of lowering medication costs is one of the few things that both the Trump and Biden administrations agree on.

Trump lifted some rules, including one that prohibits pharmacists from telling clients about cheaper medication options, and created a cap on the price of insulin. Trump also proposed giving $200 to Medicare patients to cover the cost of medication, but no definitive plan has been released.

With the pandemic only worsening in the United States, all eyes are on Biden to see how he will handle the failing health care system. In 2017, 11 million people claimed to face “catastrophic medical expenses.”

Without taking into account the amount of money lost by not being able to work, a COVID-19 hospitalization for someone who is uninsured can cost around $36,000 and $20,000 for someone who is insured.

44 million people are enrolled in some type of Medicare program, and by 2030, 79 million are expected to be. With the uncertainty that comes with COVID-19, more and more Americans are worrying about what will happen to their medical coverage.


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