As the COVID-19 pandemic continues to surge, healthcare remains top of mind for many during this election — and, according to Cornell professors, the very fabric of the country’s healthcare system is at stake.
In a recent Gallup poll, 81 percent of Americans deemed healthcare either an “extremely or very important” issue in influencing their choice for president.
Former Vice President Joseph Biden plans to make small adjustments to the Affordable Care Act, which was passed under his administration, according to Prof. Colleen Carey, policy and applied management. President Donald Trump, on the other hand, will likely “do nothing” to adjust the current healthcare system.
Trump has long been an opponent of the Affordable Care Act, but has not yet proposed any alternative plans.
The Affordable Care Act, also known as “Obamacare,” was passed in 2010 in an effort to fill gaps in the previous system of health insurance in the United States. “Prior to the Affordable Care Act, America had a system of public insurance for lower-income people and elderly people via Medicare and Medicaid,” Carey said.
But, according to Carey, the ACA created more affordable options for lower and middle-income people, as many health insurance plans previously excluded or charged unaffordable rates for those with preexisting conditions.
The ACA also gave funding for states to broaden Medicaid’s eligibility requirements, giving health insurance to 23 million people that otherwise would have been uninsured, said Prof. Sean Nicholson, policy and applied management. As of 2020, only 12 states, including Texas and Florida, have opted not to offer an expanded version of Medicaid.
“Part of the Medicaid expansion was the idea that individuals who are making less than 138 percent of the poverty line have access to Medicaid,” Carey said. Medicaid provides health services to those who qualify and limits out-of-pocket costs.
The ACA also changed the way health insurance companies could be structured and run. The legislation, for example, limited how profitable health insurance companies could be, and to a lesser extent, introduced a number of programs intended to slow the growth of medical spending, according to Nicholson.
Carey added that the ACA also offered greater protections for recipients of Medicare, such as managing the cost of prescription drugs for seniors. “Without the ACA, significant numbers of seniors would face large increases in their monthly prescription costs,” she said.
The Trump administration has long made dismantling parts of the ACA a key part of its political agenda. As a part of 2017 tax reform legislation, Congress effectively repealed the individual mandate — a fee that penalized those who could afford, but did not purchase health insurance — by reducing it to $0.
The mandate was intended to stabilize the private marketplaces created under the ACA by pushing young, healthier individuals to buy insurance. Doing so was considered an important step in making sure that health insurance companies that participated in the subsidized marketplaces could offer affordable rates to older or sicker participants.
Even so, “while this was not good for Obamacare marketplaces,” Carey said, the effect of the repeal “has not been catastrophic and the marketplaces have been able to persist.”
While Biden was not as interested as other Democratic candidates in completely overhauling the current healthcare system — he has not, for example, supported the left’s calls for “Medicare for All” — he wants to improve the ACA by providing more money for marketplaces and offering workers the chance to refuse their employer-based healthcare options, according to Carey.
“The Bidencare model would mean that anyone could opt-out of any employer-based option and they could get insurance in the public marketplace,” she said.
In the future, this change could mean that a lot of people eventually decide that they do not want to get health insurance from their employers if they could get better coverage plans through the Affordable Care Act.
Despite Trump’s continued calls to get rid of the ACA, Nicholson said he believes a repeal is unlikely if he is re-elected, even with a newly conservative Supreme Court. In 2017, the GOP narrowly failed to overturn the Act, despite maintaining control of both Congress and the White House — an election outcome that is highly unlikely.
“Should Trump win, there’s not that much he can change if he doesn’t have a Republican majority in the house and the Republican majority in the Senate,” Nicholson said.
But if Trump does finally land a deathblow against the ACA, however unlikely, Carey said it would be a disaster for Americans’ ability to access the healthcare system, particularly in the age of the coronavirus.
“We are seeing a rate of unemployment now that is higher than anything we’ve ever seen — including the Great Depression,” Carey said. “A hospitalization for the coronavirus would be a disaster if you are not health insured, both for the hospital and for the individual.”
A rise in the number of uninsured could place a significant burden on hospitals at a time when COVID-19 has forced many to the financial brink. With the pandemic forcing healthcare providers to limit profitable elective procedures, many would not be able to function if they admitted large numbers of people that cannot pay their hospital bills, Carey said.
Additionally, people may be more wary to go to the hospital if they are not insured, which could increase the mortality rate of COVID-19. However, Carey expressed optimism that the ACA is still in force, helping to offset the dramatic rise of unemployment and individuals subsequently losing their employer-provided plans.
“We are going to need a safety net for health insurance like Medicaid to get us through the virus,” Carey said.