Trump vs Biden: What Are Their Stances On Healthcare?

Now that Joe Biden will be the Democratic nominee, how does his healthcare plan compare to Donald Trump’s?
President Donald Trump (AP) and Former Vice President Joe Biden (Gage Skidmore from Peoria, AZ/Creative Commons)

President Donald Trump (AP) and Former Vice President Joe Biden (Gage Skidmore from Peoria, AZ/Creative Commons)

What is Donald Trump’s healthcare plan?

Donald Trump’s current healthcare plan can be pretty easily summed up: he doesn’t have one. He does, however, have a lawsuit pending in the Supreme Court to achieve his core vision for this critical issue. That lawsuit would eradicate the entire Affordable Care Act. You heard us. All of it. Okay, you might be wondering. That’s fine. Surely he has a replacement in mind? Especially during a worldwide pandemic that is about to reach tsunami proportions in the US?

Nope. No replacement of any kind. Granted, in his proposed budget for 2021 he has included what can only be described as a vague gesture towards what he’s calling his “health care vision.” Specifically, this amounts to a cut of $844 billion over ten years. But there is no plan. So if he wins in the Supreme Court, every American currently insured under the ACA (including expanded Medicaid), will instantly become...well...not to put too fine a point on it...uninsured.

That amounts to tens of millions of Americans. And those Americans covered by employer or private insurance policies will find themselves thrust into the jungle of unregulated healthcare á la the 1980s, subject to higher premiums and copays, lowered standards of coverage (because the ACA has a mandated 10-point basic coverage that insurers won’t have to follow), lifetime caps, increased out of pocket expenses, and being kicked off or refused coverage for pre-existing conditions. Just to name a few.

What is Donald Trump’s record on healthcare?

As a presidential candidate, Donald Trump promised that he would repeal the ACA and replace it with something he called “Healthcare Reform to Make America Great Again.” The core tenets of this reform were: 1) allow taxpayers to deduct their premiums; 2) turn Medicaid over to states in the form of block grants; and 3) allow sales of policies across state lines. At the time, policy think tanks like the Commonwealth Fund crunched some numbers to see how that would play out. The Commonwealth Fund determined that, if enacted, the federal budget would go up by $0.5 billion; the number of uninsured would balloon from 16 to 25 million; a large proportion of low-income and less healthy Americans would lose coverage; and those in private industry and employer plans would find their out of pocket costs skyrocket.

When Donald Trump took office, he had a GOP majority in both House and Senate. Their first order of business was an attempt to repeal and replace the ACA. They began by radically cutting funding and staffing to support the Marketplace website and communications. Then, in the dead of night and secret meetings that Democratic lawmakers were shut out of, they came up with a plan that would pretty much have put the whole thing into the states’ hands. They would repeal Medicaid expansion and individual subsidies and then give some of that money to the states, who would create their own plans. This would, yes, have saved $1.3 trillion over the course of a decade compared to the ACA. And according to the CBO, it would also have kicked 14 million people off Medicaid and 16 million off the individual market by 2026.

The bill passed the House, but in the face of a massive public uproar, faltered in the Senate. With their tax bill, the GOP did manage to roll back the Individual Mandate, which required all Americans to have health insurance or else pay a fine, and which was one of the key funding underpinnings that made the ACA financially viable. It also opened the ACA up to attacks in the courts, which, since 2018 voters gave the Democrats a majority in the House, has been the Trump Administration’s primary course of action. It also caused a rise in premiums for more comprehensive plans, according to the Kaiser Family Foundation.

Since that failure, the Trump Administration has attempted to pick away at Americans’ healthcare coverage in smaller ways. In January 2018, Trump proposed a plan to loosen regulations on short-term insurance, which are cheaper than those on the Exchange, but also don’t cover the 10 essential benefits that the ACA requires. These plans are basically “junk plans”—you pay in, but if you really need something, you’re out of luck. The Obama Administration limited them to 90 days. Trump proposed to expand them to 12 months.

Other changes include allowing states to require Medicaid recipients to either work or go to school. As of 2019, 37 states have opted for Medicaid expansion, and 18 of those have requested to require work and school of recipients. But only one has implemented, and two state’s programs are being challenged in lawsuits. Cost-sharing reduction subsidies to insurers have also ended. Since insurers in the ACA Marketplace are required to offer subsidies based on income, they offset the new rules by charging more for the most comprehensive plans. This tends to penalize the folks who are a little higher income and don’t qualify for subsidies.

Meanwhile, the Trump Administration has a lawsuit before the Supreme Court that would eliminate the ACA altogether, including insurance for the millions of Americans currently enjoying its coverage. So, based on all this information, how would you rate Donald Trump’s track record on healthcare?

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What is Joe Biden’s healthcare plan

Joe Biden is on the absolute opposite end of the spectrum from Trump. Where Trump would love nothing more than to eradicate the ACA and all memory of it from the face of the earth, Biden was instrumental in getting it passed during the Obama administration. Trump’s approach to healthcare seems to be more about getting people uninsured and “saving money” than anything else. Biden, on the other hand, sees healthcare as a right and necessity for all Americans. He wants to build on the improvements that the ACA has already made, expand coverage, and fix what’s broken. He also wants to reverse the deleterious effects the Trump Administration has had on the ACA, with a goal of coverage for more than 97% of Americans.

Biden’s plan is a public option that will be available regardless of insurance status. That means that those who are uninsured, insured through their employers, or self-insured will all be eligible. His plan eliminates co-pays for primary care. It limits coverage costs to 8.5 percent of the individual’s income, via tax credits. Low-income people in states that have not adopted the Medicaid expansion will be covered, and states that have adopted it will have the option of broadening coverage based on income level. He also proposes to limit what pharmaceutical companies can charge, and allow Americans to purchase their drugs from other countries.

Biden’s plan doesn’t stop there though. He’s clearly thought a lot about how to restore and promote equity for at-risk populations such as the LGBTQ community, and women’s reproductive rights. He supports codifying Roe v Wade and restoring federal funding for Planned Parenthood, doubling the federal investment in community health centers, and expanding funding for mental health services. He’ll pay for it by rolling back Trump’s tax cuts for the very wealthy and restoring the top tax bracket to 39.6% while replacing the 20% capital gains flat tax for those making over a million dollars with a 39.6% tax.

What is Joe Biden’s record on healthcare?

Biden has a bit of a checkered past voting record with respect to healthcare. He originally voted in favor of the Hyde Amendment, which bans federal funds for abortion, only reversing himself on that issue in 2019 as a presidential candidate. He also voted for an amendment that would have allowed states to overturn Roe v Wade, only to change his mind and vote against it the following year. And although on his website he says that healthcare is a right, not a privilege, his plan uses the rhetoric of providing “access” to healthcare, which is not the same thing as providing actual healthcare.

That does not, however, mean that Biden was against healthcare reform. When he ran for president in 2007, he had a healthcare proposal that was quite progressive for the time. And as Vice President in the Obama Administration, he got behind the Affordable Care Act and worked diligently to make sure it was passed. And he has been a staunch defender of it ever since, while also acknowledging that it is a work in progress and needs improvement.

Beyond this, early on in Biden’s 2020 candidacy, it wasn’t clear where he stood on healthcare. He appeared to waffle, not coming out in favor of Medicare for All but not discounting it either. He got a lot of criticism for that. But as the primary season progressed, he clearly spent a lot of energy working up a detailed plan that would be distinct for him, that would include progressive ideals, and that would also maintain what he and his colleagues had already accomplished with the ACA. He has recently come under fire for implying that getting Medicare For All passed through Congress would be “some miracle” and saying that he would veto anything that didn’t provide coverage to Americans immediately. But he wasn’t actually saying that he’d veto Medicare For All. He’s pragmatic. He lived through what it took to get the ACA passed into law. He takes into consideration what can happen and how soon and at what cost when a bill is moving through Congress.

Biden appears to be a candidate who listens, who takes the measure of what the people are asking for, and adjusts his proposals accordingly. Whether you see this as evidence of a true public servant, or evidence of a career politician who knows what to say to get elected is, of course, up to you. The question is, which would you rather have? The vague promises of a Donald Trump who seems hell-bent to eliminate healthcare coverage for all? Or the more cautious approach of a Joe Biden who knows what it takes to get things done and has a healthy respect for the limitations that lawmaking entails?

A side-by-side comparison of policies.

As we do with all our comparative healthcare plan articles, we’re providing you with a basic grid so you can see the differences between Trump’s plan and Biden’s at a glance. But here’s the problem. Trump literally does not have a plan. At all. So any comparative table we do for you could just say in each category: Nope. Nope. Nothing. Nope. You’re out of luck. Nope. We don’t want to do that, so below we’re going to do our best to cobble together a comparison that reflects what we’ve learned from recent history, against what is a clear and well thought out plan. Have fun with this. It’s really all any of us can do at this point.

Policy Question Biden's Plan Trump's "Vision"
What happens to the ACA? Stays put, gets expanded, problems fixed. Eliminated.
What if I’m insured under the ACA? Your coverage will get better and your costs will go down. If the Supreme Court rules in his favor, you will be uninsured, and you’ll have to take your chances on the private market.
What if I’m on Medicaid? You will remain covered. It’s up to the individual states. Which means, it’s a roll of the dice.
What if I’m low-income but not on Medicaid yet? You will be automatically enrolled. Same as above.
What if I’m uninsured and in the gap b/t Medicaid and being able to afford insurance? It depends on your state. States will be able to expand Medicaid to include low-income people currently not covered. You’ll remain uninsured.
What if I have private or employer-based insurance? You can keep your current insurance, or you can opt-in to the public option. It’s up to you. You’ll keep your insurance. However, your out-of-pocket costs will go up, and your protections will go down because insurers will not be as regulated as they are now. Also, good luck if you have a pre-existing condition.
What if I have a pre-existing condition? You’re covered. Welp. Good luck with that. Coverage will not be guaranteed. It will be up to the insurer, and unregulated, they’ll likely revert to their old ways.
What will my costs be? Everything ACA covers. Everything the ACA covers, plus Vision, Dental, Mental Health, Reproductive Care, Long-term Care.
How will this plan be paid for overall? Will my taxes go up? If you’re low-income or middle class, no. If you’re wealthy enough to have benefited from the 2018 GOP tax bill, those changes will be rolled back, and you’ll once again be at a 39.6% tax rate. If you have capital gains over $1 million, your current 20% flat rate will be replaced by a 39.6% rate. Well, there is no plan, really, so paying for it isn’t really a question. His “vision” is to cut $84 billion from government healthcare programs over the next decade, so there’s that. If you’re in the 0.01% and Trump has his way, you’ll get lots of big tax cuts regardless.
What if I’m on Medicare? Medicare will be expanded, your coverage will get better and your costs will go down. In Trump’s perfect world, Medicare goes away. So there’s that.

The Rantt Rundown

Healthcare is front and center on the ballot, and at this point in the primary season, Democrats have overwhelmingly voted for Joe Biden as their presidential nominee and Bernie Sanders has dropped out. Going forward, voters will be choosing between Biden’s plan for healthcare, and Donald Trump’s. Biden has a fully fleshed-out plan to get 97% of Americans covered without raising taxes on the middle class, by expanding on the ACA and fixing what’s broken in it. Donald Trump has no plan, but his “vision” as stated in his recent 2021 budget proposal is to cut a whopping $84 billion from that sector over the next decade, and he has a case pending in the Supreme Court to eliminate the ACA altogether. How do you think you’ll vote?

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Rantt 101 // 2020 / Donald Trump / Healthcare / Joe Biden