The outcome of the 2020 presidential election will not only make news, but it will also shape the future of health care — no matter which candidate claims victory. From payments to policies, to prescriptions and the ongoing rising cost of care, health care is one of the hottest items on every candidate’s ticket, with each proposing a distinct approach to keeping Americans healthy and costs down.
For Democratic candidates, the conversation has already centered around Medicare for All, and almost endless variations of the Affordable Care Act (ACA). So, what do all of these theoretical models of health care really mean? And what are the implications for consumers, the employers who offer them their insurance benefits, and the brokers who guide them through the decision
We’ve defined each model at a high level:
The ACA allowed 11 million newly eligible Americans to enroll in Medicaid.
Grow the insured population by expanding the Affordable Care Act
With over 11 million people able to gain insurance through the ACA, some think it’s the right direction to ensure that the insured population continues to grow. Revisions to the Act include addressing the individual mandate (bringing back to the table), and increasing federal subsidies so more Americans can afford or attain coverage.
Other models focus on expanding the ACA to include a public option, which is defined as federally negotiated and administered health care coverage. Most proponents of this approach believe it’s the solution to ensure that those individuals who need coverage at a minimum cost receive it, while continuing to keep the doors open to individuals interested in the marketplace options offered by private health plans.
A taxpayer-funded single-payer system would include dental, vision, mental health, and addiction services.
Medicare for All
The Medicare for All bill calls for rapid, nationalized health care for all Americans. Instead of co-pays and deductibles, Medicare for All would lower the cost of insurance coverage through a “single-payer” (the federal government) system, funded by taxes. Dental and vision would be included, as would mental health and addiction services. The role of private insurers would be refocused towards only elective medical procedures.
Where Medicare for All diminishes the role of private insurers, the public option keeps private insurers as part of a range that includes both public and private health coverage offerings. Most advocates of this scenario want to give Americans the choice to buy into Medicare instead of making it compulsory, while offering automatic coverage to certain vulnerable segments of the population, such as the elderly or newborns.
The public option would allow Americans to choose between both public and private health coverage options.
Continuation of current state
For the current administration, reform lies in repealing the ACA (also referred to as “Obamacare”) in favor of “Trumpcare,” or the American Health Care Act (AHCA).
While an early version of the Act didn’t gain enough votes in the Senate, the current version seeks to extend short-term, limited-duration health insurance plans offered by Medicare and Medicaid. Where ACA maxed out these plans at 90 days, new rules let states allow short-term plans to be sold to cover people for up to 12 months, which can be renewed for up to three years.
Under the current administration, short-term health insurance plans may provide coverage for a duration of up to 36 months.
The administration also seeks to add Association Health Plans (AHPs). These new plans would be guaranteed-issue, like ACA, and work like traditional medical coverage in that all medical costs would be covered after customers meet their deductibles. The plans differ in that the administration would reduce federal subsidies to ensure affordable care for everyone, while also seeking to eliminate the controversial “individual mandate” of the Affordable Care Act.
Association Health Plans would eliminate the ACA-imposed penalty for Americans who don’t obtain insurance.
Regardless of what happens next November, the topic of reforming and optimizing how Americans access health care will be front and center — with many implications to follow.
Learn more about our approach to health care and how we serve our members: https://www.harvardpilgrim.org/public/why-choose-us