By Ian Salisbury
October 19, 2016

More Americans than ever have coverage, but with insurers pulling out of the government insurance exchanges, premiums rising, and businesses chafing at the health law’s requirements, the Affordable Care Act (ACA) is under the microscope.

CLINTON’S PLANS

Clinton wants to save Obamacare from a Republican campaign to repeal it, which her opponent has joined with gusto.

At the Oct. 9 debate, she acknowledged the ACA’s problems, chiefly that premiums are climbing. The ACA also suffers from not enough younger people signing up—they require less care and help underwrite older folks—and from large insurers like Aetna and UnitedHealthcare exiting.

Clinton thinks problems with Obamacare can be fixed by creating a government-run health plan, known as the “public option,” to compete with private insurers that offer ACA policies. While she has provided no details about how the public option would function, the idea of the new entity is to give big private carriers price competition.

Another problem she takes on is high drug prices: Consumer spending on drugs climbed 8.5% in 2015. Under Clinton, federal agencies would require insurers to limit prices, like other nations do. She also wants to offer Medicare to people 55 years and older (the start age is 65 now).

TRUMP’S PLANS

Trump wants Obamacare dismantled. As a partial substitute for a defunct ACA, he would let you deduct health insurance premiums from your income taxes. And he wants to expand your choices of insurers by allowing carriers to sell policies across state lines. In addition, Trump would require that doctors and hospitals make prices more transparent so patients could more easily shop for the most cost-effective care.

The Trump solution to holding down drug costs is less ambitious than his opponent’s: allow imports of foreign made drugs. They tend to be cheaper than U.S.-produced drugs, a Bloomberg survey found, because governments in Europe and Canada impose price caps.

WHAT IT MEANS FOR YOU

If you buy your own insurance, Trump’s plan could spell trouble. Should you lose your job and find yourself unable to afford coverage, you would have no subsidized Obamacare policies to turn to.

Despite rising premiums, insurance plans sold on the Obamacare exchanges are often still cheaper than private alternatives. The average 2016 price of exchange plans (before federal subsidies) was $408 a month. An individual private policy under COBRA—in which you pay to stay on your employer’s plan after a job loss—is $120 more.

A recent study by the Commonwealth Fund and Rand Corp. finds that without repeal, an individual ACA policy would cost you $3,200 a year on average in 2018, but repeal would pump up the cost of a replacement policy to $4,700. If Trump pushed through his premium tax deduction, the cost would still be higher than under the ACA: $3,500.

But the loss of Obamacare would affect you even if you are covered through work. Now, because of the ACA, people under 26 can stay on their parents’ health plan. And no insurer can turn you down for a preexisting medical condition. Repeal means saying goodbye to such benefits, though some Republican lawmakers advocate retaining them.

Could Clinton’s hoped-for public insurer keep costs in check? No one is sure. But it would not be easy to fund it with federal dollars, in light of GOP opposition. Larry Levitt of the Kaiser Family Foundation, a health care think tank, notes, “That’s a difficult political road to travel.”

Clinton’s public option might help if it actually holds down the costs of competing private plans. That’s a big if. Powerful forces, like an aging population and pricey new medical technology, are putting upward pressure on costs.

Want to know what the candidates have said about pocketbook issues? Read:

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