Affordable Care Act

Joe R. Biden

  • Restore the ACA’s original objectives by rolling back Trump Administration regulations and actions and could take actions to thwart Trump’s effort to have the Supreme Court invalidate the law
  • Increase premium assistance
  • Estimates suggest that following two enhancements could reduce the number of uninsured Americans by about 4 million, while millions more would have lower out-of-pocket costs.
    • Requiring the benchmark plan to cover 80% rather than 70% of expenses.
    • Increase existing subsidies and extend subsidies to people higher up on the income scale so that coverage would never cost more than 8.5% of a household’s income.
  • Providing the public option could provide a mechanism for the federal government to extend coverage to the more than 2 million Americans who live in states that did not expand Medicaid and who currently fall into the Medicaid coverage gap, with incomes too high to qualify for pre-ACA Medicaid but too low to be eligible for ACA marketplace subsidies.
  • Public option could be made available to people with existing employer-sponsored coverage, offering an alternative for people whose employer-provided plans are too expensive or require excessive cost sharing.

Donald J. Trump

  • Supports overturning ACA
  • Repeal and replace ACA with weakened protections for preexisting conditions, reduced premium assistance

COVID Related Pandemic Plan

Joe R. Biden

  • Implement National Mask Mandate.
  • Ensure that scientists and public health leaders communicate with the US public and place primary responsibility on the federal government to provide a pandemic response.
  • Expand testing, eliminate out-of-pocket costs for COVID-19 treatment, additional pay and protective equipment for essential workers, reopen schools in-person only after sufficient reductions in community transmission, and reverse the decision to withdraw from the WHO.

Donald J. Trump

  • He does not believe the pandemic is a serious threat, sent mixed signals on masks, and wrongly suggested that US cases were increasing because more tests were being done. 
  • Delegated primary responsibility for responding to the pandemic to the states, pulled out of the World Health Organization (WHO), and pushed to reopen schools for in-person learning. 
  • Signed several major pieces of legislation on pandemic response and economic relief.

Medicaid/Medicare Expansion

Joe R. Biden

  • Lower the age of eligibility for Medicare to 60 years
  • Supports increased federal funding to states for Medicaid during the economic crisis.
  • Democratic-led government may be able to pass paid leave for people with an illness or caring for a family member, tax credits for caregiving expenses, reductions of waiting lists for Medicaid and community-based services, and new pilot programs to integrate social services with health care and home care. 
  • Supports additional investments in the home care, public health, and community health worker labor forces

Donald J. Trump

  • Elimination of Medicaid expansion
  • Cap on all federal funding for Medicaid

Healthcare Costs

Joe R. Biden

  • Reduce prescription drug costs, in part by allowing Medicare to negotiate drug prices and setting launch prices for selected new drugs on the basis of average prices abroad. 
  • Reduce surprise billing of patients in circumstances in which they have no control over who is providing treatment and consolidation in health care markets

Donald J. Trump

  • Focused some attention on prescription drug prices and spending with a series of executive orders issued last year aimed to push prices down. One of them has been effective — an agreement with insulin makers to rein in prices (perhaps fostered as much by the imminent approval of a generic substitute for the most expensive form as by political jawboning). 
  • Provisions to link prices for infused Medicare Part B drugs to prices paid in European countries or to make it easier for Americans to buy drugs at lower prices in Canada have been held up by legal issues but would probably be pursued in a new Trump administration. 
  • A recent promise to provide drug discount cards to Medicare beneficiaries lacks details on funding sources.

Healthcare for Immigrants

Joe R. Biden

  • Public Charge ruling led to reduction in immigrants with health insurance. In addition, he expanded public charge rules restricting lawful entry of people likely to receive certain non-cash public benefits, including Medicaid. 
  • Issued a proclamation allowing new immigrants to be denied entry without proof of health insurance or ability to pay for medical costs.

Donald J. Trump

  • Remove the 5-year waiting period for Medicaid and the Children’s Health Insurance Program for lawfully present immigrants. 
  • Permit unauthorized immigrants to buy coverage in the ACA marketplace, but would not make them eligible for subsidies.

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