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Where the 2020 Presidential Candidates Stand on Health Care Reform

The nation’s health care system is expected to be one of the top issues for voters in the 2020 presidential election because of the declining number of Americans with health insurance, in part due to job losses, and the rise in health care and insurance costs.

According to a report from the U.S. Census Bureau, 27.5 million people — or 8.5 percent of Americans — don’t have health insurance. In addition, a study published in the journal JAMA Internal Medicine showed that for a two-year period after the launch of Obamacare, while there was an almost 12 percent average decrease in out-of-pocket health spending, premiums rose by the same percentage — and by a bigger dollar amount.

Since World War II, most Americans have received health care benefits through their employers. In the beginning, employers paid most of the premiums and employees handled the copays and deductibles, which were manageable. That has changed in the last 20 years as health care premiums, deductibles and out-of-pocket costs have risen dramatically.

Some of the main reasons for the increases include:

  • The consolidation of health providers, which allows them to charge more.
  • More testing and more thorough examinations due, to some extent, to higher medical malpractice costs.
  • Investment in new equipment and facilities.
  • Increased prescription drugs costs, which are often the result of new pharmaceutical treatments like biologic drugs and drugs created especially for small populations.
  • Employers shifting the costs to employees through high deductibles, out-of-pocket expenses and surprise billing from non-covered health care events.

Many Americans are hoping that the two presidential candidates have viable solutions to fix the health care system. Any changes made would, of course, depend on support from Congress.

Here is a brief overview of what might change or stay the same if either Republican President Donald Trump or former Vice President and Democratic nominee Joe Biden is elected in November. The following is based on what Biden’s campaign has released. Trump’s campaign has not released a specific health care reform plan, so insights into his health care reform positions are based on the 2021 fiscal budget and on the U.S. House of Representatives Republican Study Committee efforts.

Affordable Care Act

Biden: Biden was Vice President when the Affordable Care Act (ACA) was enacted, so it is expected that he will remain supportive of the act. He has called for expanding coverage to low-income Americans and increasing the value of tax credits to lower premiums. Many Democrats have called for the expansion of the ACA.

Trump: Many Republicans in Congress and state legislatures want to reduce federal government responsibility for health coverage. President Trump and Congressional Republicans have put that idea into practice by using regulatory actions to weaken the ACA framework. Observers expect that they will continue to do that if President Trump is reelected. In particular, they want to eliminate the ACA’s essential health benefits, annual lifetime limits, preventive care with no cost-sharing, dependent coverage and “metal” plan tiers (bronze, silver etc.). Instead, they want to allow states to make these decisions. One way they would fund this is by restructuring the ACA’s premium subsidies and Medicaid expansion matching programs to fund state-administered grants to subsidize health insurance.

Republicans also have said that they do not want to allow insurance carriers to rescind, increase rates, or refuse to renew a person’s health insurance if they develop an illness after they enroll in health coverage.


Biden: Biden would like to offer a public health plan option similar to Medicare in addition to current private health plan options. Democrats have offered a variety of proposals. The common theme is to expand Medicare to at least some of the non-senior population and reduce the role of private insurance in the system. Medicare for All would be funded by increased taxes on employers and certain segments of the public instead of co-pays and deductibles. Dental and vision would be included as well. Private insurers would be limited to offering niche plans covering elective and other non-essential medical procedures.

Trump: President Trump’s 2021 budget proposes about $500 billion in net Medicare spending reductions over 10 years. The reductions would come from reducing payments to health care providers and would not directly affect beneficiaries.

Prescription Drugs

Biden: Biden wants the pharmaceutical industry to work with Medicare to set drug prices. He also wants to control pricing for new drugs; allow people to purchase drugs from other countries; implement price increase limits; and increase the supply of quality generic drugs.

Trump: Trump’s efforts have focused on price transparency; eliminating kickbacks to middlemen; and promoting the use of generic drugs. He also expanded Medicare Advantage tools to lower seniors’ costs for expensive medications. This summer Trump issued three executive orders designed to lower prescription drug prices.

Health Care Costs

Biden: Biden would like to take steps to eliminate surprise bills. A surprise bill is a medical charge an individual receives if they inadvertently received care from an out of network provider.

Trump: Republicans would like to change the tax code to provide for equal treatment of employer and individual health insurance markets. They also support the use of innovative health care solutions such as telemedicine, direct primary care, association health plans, and health sharing ministries to reduce costs. There’s also interest in expanding the use of pre-tax Health Savings Accounts (HSA), including using them to pay for insurance premiums.