Healthcare and the Affordable Care Act, explained: Trump vs. Biden

Presidential candidates Donald Trump and Joe Biden have very opposite opinions on healthcare and the Affordable Care Act. Both presidential candidates agree that health care costs should be reduced. However, the candidates differ in view in terms of how much of a role the government should have in healthcare. President Trump wants to reduce the federal government’s role in Americans’ health care, while Biden wants to expand it. They disagree on how to address the coronavirus pandemic, health coverage, driving down prescription-drug prices and lowering insurance premiums.

What Is the Affordable Care Act?

The federal Patient Protection and Affordable Care Act was signed March 23, 2010. It is also referred to as  the ACA, PPACA, “Obamacare”, or simply as “federal health reform.” According to the IRS, the Affordable Care Act sought to set certain basic coverage thresholds nationwide while providing federal subsidies for people to pay for insurance. In simpler terms, this means that the ACA was put in place to offer basic healthcare options for people across the country in order to assist those who cannot afford healthcare. Before the Affordable Care Act, many health plans and issuers could remove adult children from their parents’ coverage because of their age, whether or not they were a student or where they lived. The Affordable Care Act requires plans and issuers that offer dependent child coverage to make the coverage available until the adult child reaches the age of 26. This is beneficial because young adults do not have to worry about finding and affording their own healthcare plan after graduating from college.

Trump’s Views

Trump has pledged to repeal the Affordable Care Act and replace it with a “better alternative” but has yet to explain or act on this alternative during his time in office. According to an Oct. 8 article from the Wall Street Journal, Trump has supported key parts of a lawsuit from a coalition of Republican-led states to invalidate the ACA. The case is set to be heard by the Supreme Court on Nov. 10. 

Trump signed two executive orders in September declaring it the policy of the U.S. to provide insurance protections for Americans with pre-existing conditions and directing the Department of Health and Human Services to work with Congress to pass legislation that would protect patients from surprise medical bills.

Trump has supported work requirements in Medicaid and backs letting states pursue new arrangements to pay for Medicaid. According to an Oct. 18 article from the Wall Street Journal, Trump also wants to let states import certain drugs from other countries such as Canada to spur competition and reduce prices.

Trump has said his actions have down insurance costs, such as expanding access to short-term health plans—insurance products that cost less because they don’t generally offer the same range of benefits that ACA-compliant plans do.

Biden’s Views

Biden has stated that if he was elected he would work to undo many of the Trump administration’s health care actions. Biden stated that he would seek to reverse Trump administration changes that have undermined the ACA. He also proposed expanding the program by allowing people to buy into the public option. Biden has argued for allowing Medicare to negotiate drug prices

According to the Oct. 18 article from the Wall Street Journal, Biden has proposed bolstering the ACA by expanding federal subsidies. He wants to expand eligibility requirements for Medicare, and backs a public option plan that would let people buy into a government-run insurance plan. His plan would give everyone, including people with employer-provided health coverage, the choice to buy coverage like Medicare. This option would automatically cover low-income residents in states that didn’t expand Medicaid.

Biden has called for the federal government to subsidize insurance for some people in states that didn’t expand Medicaid by automatically enrolling them in a federal public option that would resemble Medicare.