The US presidential: Threatening future to health


The Affordable Care Act (“Obamacare”) was implemented in 2010 by the Obama administration. Since then the number of insured people has increased by 20 million individuals bringing down the uninsured rate by 43 percent compared to 2010. The incoming Presidential election endangers the reform. Mr. Trump, the Republican candidate, and Mrs. Clinton, the Democratic candidate, view health differently and this threatens to undermine what has been achieved up to now. What future awaits US healthcare?


The Affordable Care Act, “Obamacare”, has changed Americans’ lives. Since 2010 this strongly supported law has achieved good results. Most of all, it succeeded in sharply increasing insurance coverage by 20 million individuals in 2016 bringing down the uninsured rate by almost 43 percent compared to 2010. Each of the law’s major coverage provisions,such as comprehensive reforms in the health insurance market combined with financial assistance for low and moderate income individuals to purchase coverage, generous federal support for states that expand their Medicaid programs to cover more low-income adults as well as improvements in existing insurance coverage, has contributed to these gains.

Additionally, the law has supported the reduction of catastrophic costs related to health. In fact, now the majority of insurance plans must cap enrollees’ annual out-of-pocket spending. This represents a huge improvement compared to the previous situation. In fact, an analysis shows that in the decade from 2000 to 2011 big companies, with 100 or more employees, have consistently offered health insurance to their employees, while insurance coverage has been much more hit or miss for smaller firms. Moreover, the cost of insurance coverage from small and medium companies dropped dramatically. This happened because large size firms are able to negotiate lower premiums with insurance companies, because they have enough employees to reduce their actuarial risks. This is not true for the smaller ones. In fact, a high number of employees reduce risks and, in insurance vocabulary, less risk means lower insurance premiums. Obamacare reform, through its cap system has reduced this trend.

But “all that glitters ain’t gold” – Obamacare reform was thought of as a way to save money on healthcare costs but this is not true. The Congressional Budget Office (CBO) estimates that the program will cost the federal government $1.34 trillion over the next decade, an increase of $136 billion from the CBO’s predictions in 2015. In 2016 alone, Obamacare will cost a total of $110 billion. This is likely due to a higher than expected enrollment in the expanded Medicaid program created under the law. But this is not the only issue related to the program; Medicaid expanded using Federal and State funding, but not all states have to expand Medicaid.  The states that have chosen not to expand Medicaid leave 5.7 million of poorest people without coverage options. Furthermore, another 3-5 million people could lose their company-sponsored health care plans. Many businesses will find it more cost-effective to pay the penalty and let their employees purchase their insurance plans on the exchanges. Other small businesses might find they can get a better plan through the state-run exchanges. These downsides make the reform controversial.

As such, healthcare is one of the main issues with which Donald Trump could make Hillary Clinton more vulnerable. Obama’s health reform is at stake in the next presidential election. In fact,Mr. Trump sees “Obamacare” as a legislation that has to be repealed. This is the main point of his health program, though not the only one. In fact, the revoke of the existing law that inhibits the sale of health insurance across state lines, the opportunity for individuals to fully deduct health insurance premium payments from their tax returns under the current tax system, the removal of the barriers into free markets for drug providers that offer safe, reliable and cheaper products are seen as valuable measures capable of lowering healthcare costs. The proposal is projected to lead to 18 million fewer insured individuals in 2017, and more than 25 million individuals by 2018, relative to the current baseline, to decrease the total premium cost of private health insurance coverage, to increase medical productivity by 2 percent by the year 2026 relative to the current baseline, to increase provider access by 11 percent by 2026. Additionally, the proposal is expected to decrease the federal deficit by $583 billion between 2017 and 2026. But, that is not all. At the same time, Trump’s proposal would increase out-of-pocket costs for customers on the individual insurance market by $300 to $2,500 above the current average of $3,200.

However, if Trump proposes something that could appear as a step backward, Hillary Clinton keeps pursuing the fight begun in 1993 through the so called “Hillarycare” proposal. The Clinton plan, among other relevant points, expects to defend and expand “Obamacare”, to bring down out-of-pocket costs like copayments and deductibles, to reduce the cost of drug prescriptions, to enforce tools that make drug alternatives available and increase competition, broaden emergency access to high-quality treatments from developed countries with strong safety standards, and hold drug companies accountable for unjustified price increases with new penalties and to expand access to affordable health care to families by allowing them to buy health insurance on the health exchanges regardless of their immigration status. An analysis find out that Clinton’s proposals would tend to help low- and moderate-income people the most in reducing their out-of-pocket health-care costs by an average of 33 percent. Moreover, it is expected that the number of people with health insurance could increase sharply, up by as much as 9.6 million, if Clinton is elected president and the Democrat gets her health plan implemented.

The Republican plan and the Democratic plan are opposed, and the debate reveals a dilemma for democracy. The upcoming election day will unveil the future of “Obamacare”, which has been loved and hated since its implementation and after years of debating health care politics and policies, Americans remain divided over it. The November vote will confirm the divisions or will restore a united America believing in its rights and wanting concrete universal health not privileged service?

Time will tell.


Image retrieved from The Telegraph.


pietro_ghngn-300x282  Pietro Dionisio is graduated in International Relations at Florence University. Since his master degree he has been involved in global health issues about which writes articles and opinions. You can find more of his work here.


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