In 1994, when virtually every other developed country had universal healthcare, Republicans and their medical-industrial complex allies used a flood of disinformation to kill President Bill Clinton's healthcare reform bill.
For 16 long years after, Republicans blocked structural reform, with predictably grim results. By 2010, 49 million Americans lacked coverage. Medical bills accounted for 62% of U.S. bankruptcies (up from 8% in 1981). Tens of thousands of Americans a year died from a lack of healthcare coverage.
Summarizing the results of a 2010
Commonwealth Fund report which compared healthcare systems in advanced
economies, science writer Maggie Fox said that
“Americans spend twice as much as residents of other developed countries on
healthcare, but get lower quality, less efficiency and have the least equitable
system.”
Just months earlier, Democrats had
overcome a Republican filibuster to pass the
Affordable Care Act (ACA), but the law hadn’t taken effect yet.
Several frivolous court challenges and John McCain’s act of political courage later, the ACA has achieved a number of big things:
It currently provides healthcare to 40 million Americans.
The U.S. has its lowest uninsured rates ever. If not for state-level GOP resistance to Medicaid expansion, 2.3 million more Americans would have healthcare coverage.
The number of Americans under the age of 26 who receive coverage through their parents’ policies has more than doubled.
Americans with pre-existing conditions (including “up to 86 percent of people ages 55 to 64” who are not yet Medicare-eligible) are no longer completely at the mercy of healthcare industry greed.
Americans aren’t necessarily bound to toxic employers for their healthcare coverage, since they can sign up for the ACA if they leave a job with benefits. This is especially beneficial to the self-employed.
Americans who experience traumatic, life-changing events won’t be gouged due to caps on annual out-of-pocket costs and the end of insurance company limits on payouts for a given patient.
- The ACA uses rate review to make
insurance companies spend at least 80% of their budget on direct care, rather
than on expenses which have no value to patients—marketing, advertising, profit
margins, lavish CEO compensation, and the inflated administrative
costs that come with privatization and multiple billers.
Despite these big steps forward, four
decades of Republican obstruction has ensured that the United States still has
a long way to go before it catches up to its peers.
Unique
among developed countries, the United States still fails to cover
tens of millions of its citizens, which contributed to hundreds of
thousands of deaths during the COVID pandemic.
Millions with employer-based coverage
self-ration their care
to avoid exorbitant co-pays and deductibles.
Relative to other developed
countries, America still has far more
medical bankruptcies, far higher infant
mortality rates, far higher maternal
mortality rates, and higher avoidable mortality rates.
Our fragmented healthcare system
contributes to by far the highest
rates of childhood deaths of any industrialized country and
our life expectancy is lower than
some developing countries.
Because of GOP hostility to
government price regulation (a component of all
universal health systems), Americans continue to pay by far the
most for healthcare and prescription
drugs among our advanced economy peers.
His American
Rescue Plan Act increased ACA subsidies for millions, decreased
income requirements for ACA eligibility, and lured
additional states into Medicaid expansion with increased
subsidies. Thanks to Biden, new ACA enrollments hit a
record high this year.
The Inflation Reduction Act keeps ACA
subsidies in place through 2025. It caps costs for insulin
and other drugs covered under Part D of Medicare and will limit out-of-pocket
prescription drug expenses to $2,000/year for Medicare beneficiaries in 2025. It also forces prescription drug companies to negotiate the
costs of the 10 most expensive drugs (a number that will rise to 20
drugs annually.)
When blocked by Congress, Biden has used executive actions. Biden expanded postpartum Medicaid eligibility and open enrollment periods for the ACA and increased funding for navigators that assist Americans signing up for ACA coverage. He reformed Title X to extend family planning access to women who’d had it stripped away by the Trump Administration. He fixed the “family glitch,” which kept family members of people with overpriced employer-based coverage from getting coverage through the ACA.
Biden also took a number of steps to shore up the
Children’s Health Insurance Program (CHIP) and increase
funding for the Maternal, Infant, and Early Childhood Home Visiting
Program, which provides health benefits for Alaska Native and American Indian
families and pays for
itself many times over.
If given another term, and a
Democratic Congress, Biden would do more of the same, as reflected in his most recent
budget.
He would continue to expand care to the uninsured, improve coverage, and lower drug costs in the CHIP program, Medicare, and Medicaid.
He would try to extend ACA subsidies beyond 2025 and increase ACA subsidies to lower premiums.
He would raise the number of drugs Medicare negotiates to 50 annually, expand the $2,000 annual prescription drug cap to private plans, and limit co-pays for generic drugs.
He would try to make Big
Pharma pay rebates if the cost of a specific drug goes up more than
inflation, expand home care
services and access to mental
health care, and increase
research in women’s health.
He would continue to work on
lowering maternal mortality rates, improving
neonatal care, and could revive policies which were blocked in his first
two years, such as a Medicare buy-in for Americans 50 and older and a national
public option which has lowered patient costs at the state
level.
By contrast, Donald Trump shows little interest in healthcare reform. His website is conspicuously light on healthcare policy. He rarely talks of it on the campaign trail.
In a nod to his old-and-white
constituency, he promises to take on Big Pharma, but Biden is already doing this and
Congressional Republicans have actually considered a repeal of
the pricing curbs that Biden established.
Trump’s site makes a vague statement
about appointing a panel to review childhood illnesses, D.C.-speak for kicking
the can down the road.
His public statements offer mixed
messages on the big issues—if he would try to repeal the
Affordable Care Act, whether he would protect Medicare, privatize it, or cut funding, whether he
would maintain protections for people with pre-existing conditions or allow
them to go without coverage (by repealing the ACA).
Given Trump’s prior record, his lack of
clarity about future plans, and his habit of lying consistently, healthcare
advocates have no good reason to trust him.
In fact, if Trump serves a second
term with Republican majorities in Congress, the GOP would almost certainly
make our healthcare system more expensive and less responsive to the average
citizen’s needs.
The recent House Republican Study Committee budget slashes Medicaid, as did the House Republicans’ 2023 budget proposal. These cuts would be devastating to the poor, the disabled, special needs children, and millions of elderly Americans (Medicaid funds over half of America's long-term care).
The United States, alone among its
developed world peers, has 5 million
children with no healthcare. GOP plans to gut Medicaid and the CHIP
(Children’s Health Insurance Program) could cause millions more to lose
coverage.
GOP repeal of the Affordable Care Act—which Trump and congressional Republicans seem open to—could have catastrophic consequences.
Up to 30 million Americans could lose their coverage, including many of our most vulnerable citizens. Up to 129 million Americans with pre-existing conditions could again be at the mercy of healthcare-industry parasites. Medical debt and bankruptcies could skyrocket. Millions of Americans could lose access to no-cost preventive services.
Women would bear the brunt of this, stuck with co-pays for (or simply foregoing) mammograms, cervical cancer screenings, pregnancy-related services, contraception, and Pap smears while their children would lose vital pediatric immunizations.
This is just one way in which women’s healthcare would suffer under four more years of Donald Trump.
Due to his unholy alliance with
extreme-right, self-proclaimed Christians, Trump would likely
exhume his policy to cut off funding for
Planned Parenthood or any other family planning organization that
performs abortions with their own money (as opposed to taxpayer money),
thereby taking away birth control from millions of cash-strapped women and
exacerbating America’s contraceptive desert
crisis.
He would probably re-start his “final conscience rule,” which allows healthcare entities to deny reproductive healthcare to women for religious reasons.
His Justice Department would either support or (at best) present no legal challenges to red state abortion restrictions so ambiguously-worded that they actually threaten certain forms of birth control.
He would pack the federal courts with anti-choice judges like Matthew Kaczmaryk, the Trump appointee who recently outlawed mifepristone, an FDA-approved medication used to end early-term pregnancies since 2000.
He would hamper fetal tissue research and undermine the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). Again.
In effect, Republicans could inflict the worst of all worlds: big steps backward toward the highly dysfunctional healthcare system we had pre-ACA (higher costs, fewer benefits, more uninsured) with handcuffs on groundbreaking health research for our better half.
We could expect less healthcare
security, more anxiety about keeping our coverage (and our family’s coverage),
more rationing due to prohibitive for-profit mark-ups, children not getting
basic needs met, low-income disabled and elderly Americans going without, more
back-alley abortions, and shorter lifespans.
The 2024 presidential election will determine if the U.S. continues to gravitate toward the humane and effective healthcare models that exist everywhere else in the developed world or wins a race to the bottom with itself.
A slightly different version of this feature originally appeared at RawStory, with editorial assistance from Dave Levinthal
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