2020 election: Trump and Biden diverge sharply on health care

Adriana Belmonte
·Senior Editor
·9 min read

Voters are already heading to the ballot box in droves to choose between President Trump and former Vice President Joe Biden, and the issue of health care has become a key issue.

At the core of the candidate’s divergence on health care policy is the Affordable Care Act (ACA), otherwise known as Obamacare. President Trump wants to completely repeal and replace the health care law, while Biden prefers to build upon and refine the existing law.

Trump and Biden have different visions for health care. (Graphic: David Foster/Yahoo Finance)
Trump and Biden have different visions for health care. (Graphic: David Foster/Yahoo Finance)

Here’s a look at the details of the individual policies:

Affordable Care Act

Biden

Biden wants to build upon the ACA by offering a public option, automatically enrolling qualified people onto Medicaid in non-expansion states, increasing premium subsidies, and lower premiums.

Trump

President Trump has made clear that he wants to repeal the ACA but has yet to offer a comprehensive plan should the ACA be overturned by the Supreme Court and millions of Americans lose their health insurance.

“What the president put out was well short of a plan,” Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, told Yahoo Finance. “On the highest profile issue of protecting people with pre-existing conditions, the president promised to continue those protections if the ACA is overturned. But he’s offered no details about how he would do that.”

U.S. President Donald Trump (C) gathers with Vice President Mike Pence (R) and Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria
U.S. President Donald Trump (C) gathers with Vice President Mike Pence (R) and Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act to repeal major parts of Obamacare, Washington, U.S., May 4, 2017. REUTERS/Carlos Barria

And despite Trump’s vow to use an executive order to maintain protections for millions of Americans pre-existing conditions, experts are skeptical.

“It is the employer that is actually the big insurer,” Wendell Potter, a former executive for Cigna, told Yahoo Finance. “So an executive order can’t touch all that, can’t require companies to do something.”

Expert notes

Prior to the ACA, Potter said, “it was a “horrible, horrible world” in which 15 million people in the country didn’t have health insurance. As the leader of corporate communications for Cigna at the time, Potter had a message to convey.

“I was supposed to make people believe that wasn’t such a big problem, that a lot of people were uninsured by choice,” he said. “I was expected to leave out this very important point: That many of those people were not able to buy insurance at any price because they had a preexisting condition.”

LANCASTER, PA - JUNE 25: Democratic presidential candidate former Vice President Joe Biden speaks during an event about affordable healthcare at the Lancaster Recreation Center on June 25, 2020 in Lancaster, Pennsylvania. Biden met with families who have benefited from the Affordable Care Act and made remarks on his plan for affordable healthcare. (Photo by Joshua Roberts/Getty Images)
Democratic presidential candidate former Vice President Joe Biden speaks during an event about affordable healthcare at the Lancaster Recreation Center on June 25, 2020. (Photo by Joshua Roberts/Getty Images)

Medicaid

Medicaid comes with a high price tag, accounting for 16% of total national health expenditures in 2018 at $597.4 billion.

The Supreme Court ruled that it was unconstitutional for states to be forced into expanding Medicaid, declaring that it should be left up to the states to decide. Currently, there are still 12 states that have not adopted the Medicaid expansion. The rates of uninsurance in those states are significantly higher than the rest of the nation.

Oklahoma and Missouri recently approved ballot measures to expand Medicaid. (Graphic: David Foster/Yahoo Finance)
Oklahoma and Missouri recently approved ballot measures to expand Medicaid. (Graphic: David Foster/Yahoo Finance)

Trump

The Trump administration announced plans to allow states to begin putting a cap on Medicaid spending. Seema Verma, the Trump-appointed administrator of the Centers for Medicare and Medicaid Services (CMS), also began allowing states to require people on Medicaid to work or train for a job (applicable to those under 65 years old who aren’t pregnant or don’t qualify for Medicaid based on a disability).

This led to 17,000 people losing coverage in Arkansas while in New Hampshire, almost 17,000 people were about to lose coverage until the policy was put on hold.

“Government has a solemn responsibility to provide for the most vulnerable among us,” Verma said. “Part and parcel of that responsibility is making sure the Medicaid program is sustainable.”

CMS Administrator Seema Verma speaks during an event about senior citizens and the coronavirus disease (COVID-19) pandemic in the East Room at the White House in Washington, U.S., April 30, 2020. REUTERS/Carlos Barria
CMS Administrator Seema Verma speaks during an event about senior citizens and the coronavirus pandemic at the White House in Washington, U.S., April 30, 2020. REUTERS/Carlos Barria

Biden

Biden has said he wants to expand coverage to low-income Americans through Medicaid. For people in non-expansion states that would otherwise qualify for Medicaid, they would automatically be enrolled into the program through Biden’s plan.

As for the Medicaid “glitch,” which has left an estimated 4.8 million people unable to get Medicaid and left in the “coverage gap,” Biden’s plan would eliminate the income cap (400% of the federal poverty line) that is required to obtain premium subsidies. And, according to the plan, households would pay no more than 8.5% of their earnings into their health care plans.

Expert notes

Christen Linke Young, a fellow at the USC Brookings-Schaffer Initiative, called Medicaid an “extremely important component of our coverage landscape.”

“It’s not that the ACA changed how this group of people gets health insurance,” Young told Yahoo Finance. “It enabled them to get health insurance at all in the 39 states that expanded.”

Julie Rosamond discusses a new rule to require "able-bodied" Medicaid recipients to work or volunteer for a minimum number of hours each month, or be locked out of health benefits in Lepanto, Arkansas, U.S., May 2, 2018. Picture taken May 2, 2018 .     To match Special Report USA-HEALTHCARE/ARKANSAS     REUTERS/Karen Pulfer Focht
Julie Rosamond discusses a new rule to require "able-bodied" Medicaid recipients to work or volunteer for a minimum # of hours each month, or be locked out of health benefits in Lepanto, Ark. REUTERS/Karen Pulfer Focht

Medicare

Biden

Biden’s plan is to lower the Medicare eligibility age from 65 to 60, but this could cost up to an estimated $200 billion over a decade, according to the Committee for a Responsible Federal Budget. He also wants Medicare to include coverage for dental, vision, and hearing.

Bill Hoagland, senior vice president at the Bipartisan Policy Center, took issue with lowering the age of eligibility given the costs.

“The Medicare HI trust funds will exhaust we think in 2023,” he told Yahoo Finance. “When you reduce that age of eligibility for Medicare, you will speed up the exhaustion. If that were actually to come to pass, that would need a 17% reduction in Medicare payments.”

Trump

Trump has vowed to protect Medicare. However, his proposed 2021 budget cut approximately $450 billion in Medicare spending over a decade.

U.S. President Donald Trump holds up an executive order on Medicare he signed during an event at The Villages retirement community in The Villages, Florida, U.S., October 3, 2019. REUTERS/Kevin Lamarque
U.S. President Donald Trump holds up an executive order on Medicare he signed during an event at The Villages retirement community in The Villages, Florida, U.S., October 3, 2019. REUTERS/Kevin Lamarque

Reproductive health care

Trump

Trump, who has a large support base of evangelical Christians, has stated that he wants Roe v. Wade overturned. Upon nominating Amy Coney Barrett to the Supreme Court, he said it could be a possibility.

Trump has also prohibited federal funding for any clinics that provide or refer for abortion, including Planned Parenthoods. His administration has allowed employers to withhold coverage for contraceptives based on moral or religious grounds, thanks to a Supreme Court ruling. He has also reversed antidiscrimination provisions for LGBTQ patients and those who have terminated a pregnancy.

U.S. President Donald Trump speaks with Judge Amy Coney Barrett after she was sworn in as an associate justice of the U.S. Supreme Court on the South Lawn of the White House in Washington, U.S. October 26, 2020.  REUTERS/Jonathan Ernst
U.S. President Donald Trump speaks with Judge Amy Coney Barrett after she was sworn in as an associate justice of the U.S. Supreme Court at the White House October 26, 2020. REUTERS/Jonathan Ernst

Biden

Biden is pro-choice and in support of Roe v. Wade, pledging to make it “the law of the land.” The former vice president said he would nominate judges to the Supreme Court He has vowed to reverse Trump’s actions regarding federal funding, contraceptive coverage, and antidiscrimination rules.

Mental health care, opioids

Both candidates have released suicide prevention plans with focuses on veterans. Trump’s includes a budget increase for the VA, while Biden has proposed expanding mental health programs for veterans both inside and outside the VA. Biden’s plan also includes programs for reducing suicide among LGBTQ youth.

Trump

Trump has made the U.S. opioid crisis a top priority since taking office in 2017, declaring it a national public health emergency on numerous occasions.

Biden

Biden released a five-point plan to address the crisis which includes curbing overprescribing, reforming the criminal justice system, stemming the flow of illicit drugs into the U.S., holding pharmaceutical companies and executives accountable for their roles, and expanding treatment, prevention, and recovery services through a $125 billion federal investment.

Frank Huntley looks at his sculpture made out of the opioid pill bottles he got when addicted, set up outside Democratic presidential candidate and former Vice President Joe Biden's campaign event in Somersworth, New Hampshire, U.S., February 5, 2020. REUTERS/Rick Wilking
Frank Huntley looks at his sculpture made out of the opioid pill bottles he got when addicted, set up outside former Vice President Joe Biden's campaign event in Somersworth, New Hampshire, February 5, 2020. REUTERS/Rick Wilking

Prescription drug prices

Biden

Biden’s plan would repeal the “outrageous exception” that allows drug corporations to avoid negotiating with Medicare over drug prices. He would also limit launch prices for drugs that have no competition and limit price increases for brand, biotech, and “abusively priced” generic drugs to inflation.

His plan would also allow consumers to buy prescription drugs from other countries, improve the supply of generic drugs, and eliminate the tax breaks for pharmaceutical companies’ ad spending.

A pharmacy employee looks for medication as she works to fill a prescription while working at a pharmacy in New York December 23, 2009. REUTERS/Lucas Jackson (UNITED STATES - Tags: HEALTH POLITICS)
A pharmacy employee looks for medication as she works to fill a prescription while working at a pharmacy in New York December 23, 2009. REUTERS/Lucas Jackson (UNITED STATES - Tags: HEALTH POLITICS)

Trump

Meanwhile, back in September, Trump signed an executive order that expanded the drugs covered in his “most-favored-nation price” to include Medicare Parts B and D.

“It is unacceptable that Americans pay more for the exact same drugs, often made in the exact same places,” the order said.

Surprise billing

Biden

Biden’s plan would prohibit health care providers from charging out-of-network rates when the patient has no control over who their provider is. For example, when someone is hospitalized and needs surgery, the anesthesiologist might be out of network but the surgeon is not. The patient would be hit with the full medical bill for the anesthesiology services.

Sanathan Aiyadurai, 27, and Diego Montelongo, 27, who are medical students, review a COVID-19 patient's status during a daily meeting lead by Dr. Joseph Varon, 58, the chief medical officer at United Memorial Medical Center (UMMC), during the coronavirus disease (COVID-19) outbreak, at UMMC in Houston, Texas, U.S., July 10, 2020.  REUTERS/Callaghan O'Hare     SEARCH "COVID-19 HOUSTON VARON" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Sanathan Aiyadurai and Diego Montelongo review a COVID-19 patient's status during a daily meeting lead by Dr. Joseph Varon at United Memorial Medical Center (UMMC) in Houston, Texas, July 10, 2020. REUTERS/Callaghan O'Hare

Trump

End surprise billing as well. Through an executive order, the White House directed the Department of Health and Human Services (HHS) to work with Congress to find a solution to ending surprise billing. If one isn’t reached by the Dec. 31 deadline, HHS “shall take administrative action” to prevent patients from receiving bills for unexpected out-of-pocket expenses.

Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells.

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