(Reuters) – Democratic presidential candidate Joe Biden wants to expand the Affordable Care Act, President Barack Obama’s signature healthcare legislation, and then name him.
Republican President Donald Trump wants to end it completely and replace it with something that has yet to be defined.
Part of an ongoing debate about the best approach for the economy is about price tags. Bidencare is expected to increase federal health care spending by $ 2 trillion or more over 10 years. Trump’s approach is to keep federal spending stable or cut it.
Bidencare supporters point to the stimulating effects of government spending, especially in times of economic distress, and the benefits of insuring more people in the midst of a pandemic. Those who prefer Trump’s approach say it would avoid debt or that tax hikes, they say, would dampen future economic growth.
The United States has about 30 million people without health insurance tmsnrt.rs/3mzqQxC now, up from around 46.5 million in 2010, when the ACA was enacted.
Graph – Under ACA, decrease in the number of uninsured:
Bidencare would reduce that figure from an additional 15 to 20 million, according to an analysis by the Committee for a Responsible Federal Budget. Trump shouldn’t be trying to reduce this.
Healthcare spending accounts for 17% of the US economy, far more than any other industrialized country, so the Trumpcare vs. Bidencare debate is no small economic affair. It’s further complicated by the fact that the extra spending doesn’t translate into a healthier population than other counties.
“Improving healthcare performance is a critical part of strengthening America’s health, economy, and fiscal future, and should be a top priority for the next President and Congress.” , said Michael Peterson, CEO of the Peterson Foundation.
BIDENCARE FOCUS ON LOW-INCOME AMERICANS
Bidencare would cover more Americans by increasing purchases of health insurance subsidized through tax credits.
It would also offer a “public option”, allowing anyone to buy it, even if their job offers private insurance. Low-income families excluded from the ACA’s expanded Medicaid eligibility because of where they live could get it without a premium.
Any boost to health and financial stability will likely be the biggest for millions of low-income households, especially Latin American and black families who have been particularly hard hit during the pandemic.
For these groups in particular, says Helen Levy of the University of Michigan’s School of Public Health, being able to accumulate assets “is really important if you’re thinking about supporting economic mobility.”
Minorities contract and die from COVID-19 at higher rates than whites, data shows. This is probably due in part to the fact that blacks and Latinos are more likely to work in jobs that put them at higher risk of transmission.
But even without COVID-19, minorities face higher rates of chronic disease and earlier death than whites. They also have lower health insurance rates despite substantial gains since the advent of ACA, according to a study by the Kaiser Family Foundation.
Biden said he would pay for his plan by raising taxes for the rich and use the influence of expanded public insurance to cut medical costs.
The increase in the number of Americans insured could have positive economic consequences.
There is evidence that uninsured people who become ill receive care in expensive environments like emergencies, says Gerald Kominski, professor of public health policy at UCLA. It hurts their financial health and, when they cannot pay, puts a strain on the finances of the hospitals that provide their care, with taxpayers bearing part of that bill as well.
People in states with uninsured rates falling under Obamacare had less past due debt, were less likely to use payday loans or file for bankruptcy, had better credit, and were less likely to be evicted than those states that have not extended eligibility for Medicaid under the ACA.
“The only reason people should buy insurance, from an economist’s point of view, is to protect them from catastrophic losses,” says Sayeh Nikpay, a professor at the University of Minnesota.
LESS CLEAR, BUT CHEAPER TRUMPCARE
Trump tried unsuccessfully to get Congress to repeal the ACA during his first four-year term, and is expected to continue in some form or another during a second term.
The Supreme Court is due to hear a challenge to the law a week after Tuesday’s presidential election. A decision to dismantle the ACA would jeopardize the coverage of 21 million Americans, according to the Urban Institute, although most legal scholars do not expect the court to do so.
If so, Trump hasn’t specified a plan to replace him. One model may be the Healthcare Choice Proposal, developed by conservative health policy experts at the Galen Institute and the Heritage Foundation.
The plan would return the money currently used for ACA to states to help people purchase private health insurance and provide coverage to low-income households.
Analysis by right-wing nonprofit think tank American Action Forum found that the proposal would cut bonuses from 18% to 24%. The number of uninsured would remain stable.
“The macroeconomic effects would be better than the current law or proposals to devote more public resources to ACA,” says author Doug Badger. Reducing premiums, he said, would be the “best form of economic stimulus” because it would put money in the pockets of ordinary Americans.
This analysis is disputed.
Bidencare’s high price concerns Bipartisan Policy Center Senior Vice President William Hoagland, a former Republican lawmaker staff. But, he said, it’s worth paying for wider access to health insurance, which he said would lead to a stronger economy.
“I’m going to side with the fact that a healthy country and a reduction in chronic disease improves productivity, and improving productivity increases economic growth,” he said.
Report by Ann Saphir; Editing by Heather Timmons and Jonathan Oatis