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 Bill Clinton said this month that while millions more Americans now
have insurance coverage under President Barack Obama’s signature
2010 healthcare law, small businesses and some families are still
“getting killed” by surging healthcare costs. He later clarified
that he was not criticizing the entire initiative, he was just
making an argument for fixing it.
Still, Clinton's comments may not have been so crazy. He put a
spotlight on an uncomfortable truth: after six years, billions of
dollars and a sweeping reform that stands as Obama's single biggest
domestic policy achievement, health care is still unaffordable for
many Americans.
Americans are growing increasingly anxious about rising healthcare
costs, and critics of the law have said it is not living up to its
promises. Two of the nation’s largest health insurers, Aetna and
United Healthcare, are also pulling out of the state-based health
insurance exchanges that are the best-known creations of Obamacare.
Clinton says she wants to save the best of Obamacare, also known as
the Affordable Care Act, while reducing costs. Trump says it is an
expensive "disaster" that is on track to implode in 2017. He wants
to replace it with something cheaper.
Whoever wins the presidency on Nov. 8 will likely face pressure to
move quickly to reshape a healthcare initiative that affects
millions of Americans.
WHY CONSERVATIVES THINK OBAMACARE IS CRAZY
Republicans opposed Obamacare from the start, labeling it a
government intrusion into the healthcare market.
Some of them say the individual exchanges where Americans shop
online for coverage are already in a "death spiral." They warn that
with fewer consumers using the exchanges, more health insurers will
exit them, sending premiums even higher, and further deterring
people from signing up.
As the U.S. population ages, U.S. spending on healthcare - $2.9
trillion in 2014 - is projected to rise to more than one-fifth of
the nation's gross domestic product. Spending rates under Obamacare
did slow for a time, but they are on the rise again.
Trump has proposed getting rid of the exchanges and setting up
tax-free health savings accounts for people with high-deductible
insurance plans. He has also said he would set up state-based
high-risk pools for people with medical conditions that make it hard
to get coverage on their own. He also wants to allow companies to
sell insurance across state lines to boost competition and drive
down prices.
His advisers say he would draw on a plan proposed by Republicans in
the U.S. House of Representatives, which includes a refundable tax
credit to help Americans buy individual plans.
Republicans, like Trump, also want to change how they fund Medicaid,
which serves poor families. Obamacare increased federal funding to
states that expanded the program to more people with low incomes.
Now Trump wants to limit funding by switching to pre-set, block
grants.
Health policy experts are skeptical selling insurance across state
lines would do much to rein in health insurance costs. And health
wonks on both sides of the aisle said Republicans would likely balk
at any proposals that threatened to yank health insurance away from
20 million people.
"Even Republican members of the House and the Senate are going to
end up resisting rolling back the Medicaid expansion if that means
that lots of people in their states would go uninsured," said Jim
Capretta, a health policy expert at the right-leaning American
Enterprise Institute.
LIBERALS DON'T THINK IT'S CRAZY, BUT...
Liberals like former Democratic presidential candidate Bernie
Sanders haven't called Obamacare crazy, but Sanders does believe it
doesn't go nearly far enough. During his campaign, he proposed
replacing it with a single-payer insurance system he called
“Medicare for all,” based on the government plan for elderly and
disabled Americans.
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Hillary Clinton’s plan doesn’t go that far, but she would build on
Obamacare by expanding tax credits for people shopping on the
individual marketplaces, letting Americans buy into Medicare at a
younger age, and adding a “public option,” or a government-run
insurance plan to compete with private insurers on the exchanges.
She has also proposed reducing Americans’ out-of-pocket expenses
outside their private insurance by offering a new refundable tax
credit, and she would give states more federal funding to expand
Medicaid for low-income people.
Two-thirds of states expanded Medicaid under the 2010 law, and
that’s where most of the newly insured people got coverage. Policy
experts said that after Obama leaves office, more Republican-led
states that objected to a plan so closely identified with Obama
might be willing to expand Medicaid too.
Clinton’s ability to expand tax incentives likely depends on which
party controls the U.S. Congress. And while some states could act
independently to launch public plans on their exchanges, many
Republicans view the idea as wildly expensive and would strongly
resist any effort by Clinton to require them nationwide.
WHAT EVERYONE THINKS IS CRAZY – DRUG PRICES
Obamacare did little to deal with soaring drug prices for lifesaving
treatments like Mylan NV's EpiPen. Democrats and Republicans say
that’s a problem for the next president, even though it’s getting
little attention on the campaign trail.
Trump and Clinton both want Americans to be allowed to buy cheaper
drugs from overseas (Americans pay the highest prices in the world
for drugs). Former Democratic U.S. Representative Henry Waxman made
a similar proposal in 2009, but he was defeated by pressure from
drug companies, which would likely oppose it again.
Clinton says Medicare should negotiate drug prices with companies,
using its 55 million users to get a better deal. Trump made a
similar call during the Republican primaries but it does not appear
on his campaign website now.
Some health policy experts believe drug companies would respond to
lower prices for Medicare patients by raising prices for everyone
else. And to negotiate better prices, Medicare would have to be
willing to stop covering certain drugs, which would be unpopular,
they say.
Clinton has also suggested creating a commission that would watch
for sudden spikes in prices of older life-saving drugs, a proposal
that health policy experts said is achievable through rule making
rather than legislation. She has also proposed a cap on drug
co-payments.
Clinton has already put Wall Street on watch. Her tweets have
brought down shares of Mylan and Valeant Pharmaceuticals
International, which helped push many institutional investors out of
healthcare stocks.
Drug companies are already responding to political pressure. Botox
maker Allergan Inc, for example, recently committed to keeping price
increases below 10 percent.
(Reporting by Caroline Humer in New York and Emily Stephenson in
Washington; Editing by Caren Bohan and Ross Colvin)
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