The big issue neither candidate talks much about - health care
This has been an unusual election in many ways, but one in particular is that health care has largely been shunted to the side by other issues such as inflation and immigration.
However, Pew Research finds voters still rank health care as the second most important issue behind the economy. A lot of things can fall under the heading “health care” including women’s reproductive health, preserving the Affordable Care Act and Medicare and Medicaid.
However, if you listen to the candidates, many of these issues seem settled — kinda.
Donald Trump has pledged that Social Security and Medicare would be protected (with no details on how to keep them solvent). Vice President Harris has made the same pledge (with no details on how to keep them solvent).
In the debate, Trump said he would keep the Affordable Care Act in place unless he could come up with something better. Pressed if he had a plan, he said he had “concepts of a plan.” How many years have Republicans been saying they will repeal the ACA and replace it with something “better” but never actually produced a plan? It is hard to take them seriously.
In recent days, Vice President Harris has proposed an expansion of Medicare to cover home health care for the elderly. Many recognize this hole in the Medicare/Medicaid system and proposals have been circulating in the bureaucracy for some time. There is some bipartisan support, but, as always, the question is how to pay for it.
Harris says she will be more aggressive in negotiating lower drug prices and apply the savings to the new program. The Congressional Budget Office currently estimates that Medicare’s ability to negotiate drug prices will reduce Medicare outlays $100 billion over 10 years.
Another issue that will come up quickly in the new president’s term is the tax credits (PTCs) that subsidize premiums for people getting coverage under the Affordable Care Act. They are set to expire in 2025, and there is a good chance they will be wrapped up with the debate over extending the Trump tax cuts that expire at the same time. For a family of four making $60,000 a year, premiums would rise from $1,200 a year with the PTC to $3,912 without.
Preserving those ACA tax credits is one of the proposals on healthcare in the 81-page booklet the Harris campaign has prepared on her proposed economic policies. In addition to the tax credits and lowering drug prices, she wants to put more emphasis on the fentanyl crisis.
The ACA has helped insure more than 45 million Americans and reduced the number of those uninsured to just 7.7% of the population.
During Trump’s four years in office, he tried to repeal the ACA and failed thanks to three Republican Senators — Susan Collins, Lisa Murkowski, and — of course — John McCain. However, during Trump’s four years, there was essentially no growth in the number of enrollees because he cut the funding for outreach.
That was restored under President Biden and four more states — all “red” — have bought into the Medicaid extension, increasing the numbers of participants substantially.
Health care ranks highly as an issue because there are still serious problems with our system. For example, about 30% of Americans are not taking their medications because of cost. It is estimated that 1.1 million Americans could die over the next decade because of this. And about a third of Americans are burdened by medical debt.
The ACA obviously did not solve all the problems with America’s health-care system, but it provided a lifeline to millions of Americans, especially those previously denied coverage because of pre-existing conditions.
Perhaps things are not as settled as they seem.
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• Keith Peterson, of Lake Barrington, served 29 years as a press and cultural officer for the United States Information Agency and Department of State. He was chief editorial writer of the Daily Herald 1984-86. His new book “American Dreams: The Story of the Cyprus Fulbright Commission” is available from Amazon.com.