Health care remains a top priority of voters. The cost continues to increase, while restrictions on what’s covered and which doctors you can see keep tightening. The COVID pandemic has made the problems in health care access and cost all the more alarming.
If President Trump is re-elected, he and the Republicans in Congress won’t reduce these trends – they’ll accelerate them. Here’s what they seek, for the various forms of health coverage we have.
This is the federal program for people 65 and older and many disabled Americans. The Republicans want to put Medicare in the hands of insurance companies. That wastes vast amounts of taxpayer funds, and lets those companies control who you can see and whether specific treatments get paid for.
Their chief goal is to turn Medicare into a voucher system, where the government gives you a set monthly amount to help you buy an insurance policy. The insurance companies, not the government, will then decide what will be covered. The government voucher won’t rise with medical inflation, and so it will pay for less and less each year. The average senior will pay $12,000 out of pocket annually, instead of $6,000, according to the Congressional Budget Office.
If they don’t win their voucher system, their Plan B is to greatly increase the use of the Medicare Advantage program – in which insurance companies already control the Medicare of those who choose it. It’s a voucher system on training wheels, and Trump is trying to expand it.
This is the federal system for low income people of all ages. Much of Medicaid goes for health care for non-seniors, but two-thirds of it pays for long term care, especially nursing homes. It is critical for all the seniors who end up in nursing homes. It’s paid for by roughly half federal money and half state money.
The Republicans want to turn it into a flat grant system. That means the federal government gives each state a total set amount per year, or per enrollee. It will rise according to overall inflation, but not fast enough to cover medical inflation.
Therefore, over time, the federal share covers an increasingly smaller portion of the overall cost. That forces states to either jack up taxes to cover the shortfall, or start reducing Medicaid benefits and/or eligibility.
ObamaCare (aka Affordable Care Act)
Many people understand that the Republicans want to repeal ObamaCare, and that Trump is trying to eliminate it in court. If that were to happen, tens of millions of people would be hurt. A new Supreme Court justice to replace Ruth Bader Ginsburg will likely be rammed through quickly, and could tip the balance against ObamaCare.
ObamaCare increased the income eligibility for Medicaid, which most states took advantage of. Those newer enrollees would be thrown off the roles. The other major ObamaCare program are subsidies to help many people afford to buy insurance. If those subsidies disappear, another set of millions won’t be able to afford good coverage.
ObamaCare stopped insurance companies’ ability to deny coverage for pre-existing conditions, and closed up the Part D “Donut Hole.” These would be reversed, too. Although Trump and the Republicans say they’ll protect pre-existing conditions, they actually intend to let insurance companies decide.
Biden and the Democrats, in contrast, would push for an improvement of Obamacare, in the form of a Public Option, to allow all Americans to buy coverage at a more affordable price.
What about the majority of Americans, who get employer health coverage? For most of them, that coverage is the best deal around. However, that deal slowly deteriorates every year: Higher premiums, deductibles, and co-pays. Greater restrictions on which doctors you can see.
Their health care will continue to get less affordable every year. The only fix for that is a very big one – a universal public health care system, which everyone would get regardless of their work status.
That won’t be enacted anytime soon. Our immediate need is to block Trump and the Republicans’ intention of making everyone’s health care much worse.
By By Buddy Robinson. Robinson, an expert on Social Security, Medicare and Medicaid in Minnesota, is known for his work educating Union members, their families and the community about how to best receive their benefits, as well as policy issues.