Health care has rapidly ascended to a prominent position in the final push toward the presidential election, with potential consequences that could redefine the Affordable Care Act (ACA) and impact coverage for over 40 million Americans. As the election nears, the stakes couldn’t be higher for millions relying on the ACA’s protections.
While reproductive rights have consistently dominated discussions, health care has largely lingered in the background throughout most of the campaign season. However, remarks made by former President Donald Trump and his running mate, Ohio Senator JD Vance, regarding potential alterations to the ACA have subjected Republicans to increased scrutiny and debate.
Recently, more than 1,500 physicians across the nation joined forces to issue an open letter demanding Trump provide clarity on how he intends to modify the ACA. They emphasized the necessity for such information to enable voters to make well-informed choices in the upcoming election. The letter originated from the Committee to Protect Health Care, a widespread advocacy organization dedicated to empowering health-care professionals.
Larry Levitt, executive vice president for health policy at KFF—an influential health information nonprofit—remarked, “It’s remarkable that a decade and a half after the ACA passed, we are still debating these fundamental issues.” He highlighted the ongoing struggle between Democrats, who strive to safeguard protections for individuals with preexisting conditions through adequate funding and regulations, and Republicans, who often advocate for reduced federal oversight, which could inadvertently lessen protective measures for vulnerable populations.
The two major political parties are presenting fundamentally divergent visions for the ACA, a transformative statute established under former President Barack Obama. This groundbreaking law established essential benefit benchmarks, increased the Medicaid eligibility pool, and ensured that consumers with preexisting conditions could not be denied coverage based on their health status.
Trump, who has repeatedly attempted to dismantle the ACA without success, announced during the September presidential debate that he possess “concepts of a plan” to adjust or replace the existing legislation. Despite the moment becoming a source of jest due to Trump’s prior unfulfilled promises to unveil a health insurance alternative during his presidency, Vance went on to elaborate on their proposed changes.
He stated that, under a future Trump administration, there would be an emphasis on deregulating insurance markets—a shift that some health analysts argue could enhance consumer choices but potentially undermine safeguards for those with preexisting conditions. Vance appeared to modify his stance during the vice presidential debate, acknowledging that the ACA’s protections for individuals with preexisting conditions ought to remain intact.
Potential health care reforms may find their way into a major tax proposal in 2025, according to Sen. Tom Cotton (R-Ark.) in remarks made to NBC News. This legislative maneuver could also open avenues for alterations in Medicaid. Conservative factions have long advocated for a restructured health insurance program for low-income and disabled individuals that would shift from the current funding model—where the federal government contributes a percentage of each state’s overall Medicaid expenses—to a system featuring capped funding limits or block grants. Advocates of the ACA warn that this approach could significantly offload costs onto states, potentially leading most, if not all, to eventually retract the program expansion.
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Democrats are strategically attempting to turn Trump’s remarks into a political liability by showcasing advertisements that assert he lacks a concrete health plan to replace the ACA. The Harris campaign has also circulated a comprehensive 43-page report titled “The Trump-Vance ‘Concept’ on Health Care,” which claims that Trump and Vance’s policies would ultimately “strip away coverage from individuals with preexisting conditions and inflate costs for millions of Americans.”
Republicans faced significant challenges in the past while unsuccessfully pushing to repeal the ACA, resulting in the law gaining popularity among the public. Furthermore, the perceived threat to protections for individuals with preexisting conditions was pivotal in helping Democrats regain control of the House in the 2018 midterm elections.
According to a KFF poll conducted last winter, two-thirds of surveyed individuals expressed that it is critically important to uphold the ACA’s prohibition against charging people with health issues higher premiums or denying them coverage altogether.
“In this election, people are prioritizing issues that have a direct impact on their families,” asserted Robert Blendon, a professor emeritus of health policy and political analysis at Harvard University. “If voters feel their health insurance could be compromised by Trump’s proposals, it might significantly influence their choices at the ballot box.”
During a September 15 appearance on NBC’s “Meet the Press,” Vance attempted to downplay the ramifications of the ongoing health care debate.
“You want to ensure that preexisting condition coverage remains intact, facilitate access to preferred doctors for individuals, and pursue a deregulatory agenda that allows for customizable health care plans,” he articulated. He added that promoting choice in health care options would be the most effective solution to guarantee coverage for everyone, rather than funneling all individuals into the same insurance risk pool.
Risk pools are essential to effective insurance models, representing groups who share the financial burden of health-related expenditures. Under the ACA framework, participants, regardless of health status or preexisting conditions, are typically pooled together. This arrangement helps regulate premium costs by leveraging the lower expenses associated with healthier individuals to offset the higher costs incurred by those with more severe health issues. In contrast, segregating individuals with chronic health conditions into separate pools could lead to exorbitantly high costs, potentially making coverage prohibitively expensive for those in need.
The Harris campaign has highlighted potential negative consequences, asserting in their recent report that “health insurers will revert to discriminating against individuals based on their health status.”
Despite this, some critics of the ACA contend that there are viable methods to separate risk pools without compromising coverage access for at-risk populations.
“Naturally, this concern has been exaggerated for political gain,” remarked Theo Merkel, a former aide to Trump who now serves as a senior research fellow at the Paragon Health Institute, an organization focused on health research and market-oriented policy suggestions. He claimed that incorporating short-term insurance options will not only preserve the ACA marketplace but also provide consumers with more economical alternatives. Merkel noted that the Trump administration’s policy allowing the maximum duration of these plans was subsequently curtailed by the Biden administration to a four-month limit.
Individuals eligible for subsidies are likely to prefer comprehensive ACA plans due to their affordability, enhanced by available financial assistance. Consequently, he argued, the protections for preexisting conditions within the ACA would remain intact, while the introduction of short-term plans could offer a more accessible option for consumers who do not qualify for such financial aid.
In jurisdictions permitting the purchase of non-ACA-compliant plans outside of state exchanges, the performance of those exchanges has been markedly better compared to states that do not allow this practice. Merkel added that implementing a reinsurance scheme, akin to one currently functioning in Alaska, could further mitigate premium costs by reimbursing insurers for covering high-cost claims.
Conversely, advocates of the ACA argue that isolating healthy and unhealthy individuals into distinct risk pools will inflate insurance costs for individuals with chronic conditions, and that easing access to long-term short-term health plans could lead to detrimental outcomes.
“It uninsures people when they get sick,” stated Leslie Dach, executive chair of Protect Our Care, an organization campaigning in favor of the health law. “There’s absolutely no justification for this approach. It is both unethical and irrational from an economic standpoint. Proponents will disguise their actions as improvements, but that narrative is entirely false.”
Harris is aiming to maintain the temporary subsidy enhancements that have expanded access to affordable health coverage under the ACA for millions. With these expanded subsidies affecting roughly 20 million people set to expire at the end of 2025, a significant political battle looms on Capitol Hill between Republicans advocating for their termination and Democrats insisting on their permanence.
In September, Democrats introduced a bill to secure the permanence of these expanded subsidies. However, a significant hurdle is the Congressional Budget Office’s estimate, which suggests that such a move could escalate the federal deficit by over $330 billion within the next decade.
The ability of either candidate to meaningfully expand or alter the ACA ultimately rests in Congress’s hands. Current polling indicates that Republicans are positioned favorably to reclaim control of the Senate, while the prospects in the House remain less certain. However, the margins will likely be razor-thin. In any given scenario, many proposals concerning the expansion or restriction of short-term health plans can also be pursued through executive actions and regulatory adjustments, akin to the maneuvers employed by both Trump and Biden during their respective tenures.
Interview with Dr. Emily Thompson, Healthcare Policy Expert
Editor: Thank you for joining us today, Dr. Thompson. With the upcoming presidential election, health care is rising to the forefront of political discussion. Why do you think the Affordable Care Act (ACA) has become such a pivotal issue this election cycle?
Dr. Thompson: It’s great to be here, thank you! The ACA represents a fundamental change in how millions of Americans access health care. With over 40 million people relying on its protections, any proposed changes to the ACA could significantly impact their coverage and health outcomes. As candidates make claims about health care reform, voters need to understand the implications of those changes.
Editor: Recently, over 1,500 physicians signed an open letter urging former President Trump to clarify his plans regarding the ACA. What does this say about the current political climate surrounding health care issues?
Dr. Thompson: It highlights a growing concern among healthcare professionals about the clarity and feasibility of proposed reforms. Physicians are on the front lines, and they want to ensure their patients have access to the necessary care. The insistence on specifics from candidates reflects a desire for transparency in health policy, which is crucial for voters to make informed decisions.
Editor: There’s been a lot of back and forth between Democrats and Republicans regarding preexisting conditions and ACA protections. What are the ramifications of the GOP’s proposals on this front?
Dr. Thompson: The GOP’s push for deregulation in insurance markets could lead to increased premiums for individuals with preexisting conditions, making coverage less accessible. The ACA was designed to prohibit discrimination based on health status, and any steps away from that framework could disproportionately affect vulnerable populations. The ramifications could lead to many losing coverage or being unable to afford necessary treatments.
Editor: Trump’s comments during the debates raised eyebrows, with an assertion that he has “concepts of a plan” without clear details. How might this ambiguity affect voter perception?
Dr. Thompson: Ambiguity around health care plans can create uncertainty and fear among voters. If voters are unsure of how proposed changes will affect their health care, it could sway their decisions at the polls. Public opinion polls show that maintaining protections for preexisting conditions is a priority for many Americans, so failing to provide a coherent and concrete plan may turn voters away.
Editor: Democrats are shifting strategies to spotlight these potential risks. How effective do you think these efforts will be in influencing the electoral outcome?
Dr. Thompson: Targeted campaigns that articulate the risks of losing ACA protections can resonate deeply with voters, especially those who have benefited from its provisions. If Democrats successfully demonstrate that the Republican plan could lead to increased costs and loss of coverage, they may energize their base and sway undecided voters who prioritize health care in their decision-making.
Editor: Lastly, as we approach the election, how can the general public stay informed about these critical health care discussions?
Dr. Thompson: Engaging with reliable news sources, participating in community forums, and advocating for health policy discussions with politicians are great ways to stay informed. It’s essential to ask questions and demand clarity from candidates about their health care proposals to ensure that voters’ needs and concerns are being addressed.
Editor: Thank you, Dr. Thompson, for your insights on this pressing issue. I appreciate you sharing your expertise with us today.
Dr. Thompson: Thank you for having me! It’s vital that we continue this conversation as we move closer to the elections.
Ht Republican proposals as potential threats to health care coverage. How effective do you think this strategy will be in influencing voter choices?
Dr. Thompson: It could be quite effective. Health care is a deeply personal issue for many voters, especially those who have experienced problems with access or affordability. By framing Republican proposals as risks to vital protections, Democrats can tap into widespread fears that changes may lead to instability in health care coverage. If they successfully communicate that message, it could resonate with undecided voters who prioritize health care security for their families.
Editor: Lastly, as we look ahead to the next Congress, what potential scenarios do you foresee regarding health care legislation, regardless of who wins the presidency?
Dr. Thompson: It’s likely that any major changes to the ACA will be contentious and could lead to gridlock, particularly if there’s a divided Congress. However, both parties may find common ground on specific issues, such as protecting individuals with preexisting conditions. Moreover, there could be opportunities for executive actions that sidestep congressional hurdles, similar to what we’ve seen in past administrations. the outcomes will largely depend on public sentiment and voter mobilization in the lead-up to the election.
Editor: Thank you, Dr. Thompson, for your insights on these crucial health care issues as the election approaches.
Dr. Thompson: Thank you for having me, and don’t hesitate to reach out if you need further information as the election unfolds!
