Twenty-nine million Americans had no health insurance last year, according to the U.S. Census Bureau, including 1.2 million North Carolinians.
The percentage of Americans without coverage has been growing every year since 2016, and it's expected to grow again this year. In North Carolina, an estimated 238,000 people lost coverage – along with their jobs— just in the first few months of the pandemic.
There’s a lot of speculation that U.S. Supreme Court nominee Amy Coney Barrett would vote to overturn the Affordable Care Act when the Court rules on the law later this year. That’s refocused attention on the presidential candidates’ health care plans.
WFAE’s Dana Miller Ervin is breaking down those plans for us. We’ll focus on President Trump’s plan Friday. On Thursday, she talked about the plan put forth by Democratic nominee, Joe Biden.
Lisa Worf: What’s in the Biden plan?
Dana Miller Ervin: Well, it’s a big plan. But its primary focus is on expanding health care coverage, although it also includes a number of features which Biden says would lower costs.
One of the ways it would expand coverage is by lowering the age for Medicare eligibility to 60. Right now it’s 65. But the primary way it aims to expand coverage is by creating a public option — which is a government-run health care plan – like Medicare. The public option would negotiate prices with hospitals and other providers to lower costs, and then people could buy into that.
Worf: Who can buy into the public option?
Ervin: Anyone who doesn’t qualify for another government health care program, like Medicare or Medicaid, or who doesn’t get insurance through their job.
So that would include people who can’t afford insurance through the individual market. It also includes people who are offered coverage at work, but can’t afford it.
And it includes the estimated 600,000 North Carolinians who would be eligible for coverage if North Carolina expanded its Medicaid program to include people earning up to 138% of the federal poverty level. Those are families of four earning less than $35,535. They don’t qualify for insurance now, of course, because the state hasn’t expanded the program.
Worf: During Tuesday night’s debate, the president attacked the Biden plan, saying it would hurt people with private coverage.
Donald Trump: "You’re going to extinguish 180 million people with private health care, that they’re very happy with."
Joe Biden: "That’s simply not true."
Donald Trump: "Well you’re certainly going to socialist ... you’re going to socialist medicine."
Worf: What’s the truth here?
Ervin: The plan Biden lays out does not eliminate private health care, although some people may choose to sign up for a public option if they can’t afford their private plan. And it is not socialized medicine in which the government owns and operates the hospitals and medical clinics. It expands government-run health insurance.
Worf: One of the complaints about Obamacare — at least from some people — is that the premiums are too expensive. The average monthly premium for a family of four is $1,520 if there are no subsidies.
Does the Biden plan propose a way to fix that?
Ervin: The basic problem with the cost of premiums is that once you start covering preexisting conditions, maternity care, prescription drugs and mental health services – all the things the Affordable Care Act requires — it gets expensive.
So the Trump plan, which we’ll talk about Friday, deals with that by offering coverage that doesn’t include everything. Biden’s plan says it will negotiate down prices but also provide subsidies and tax credits. And it will limit the cost of coverage so no one will spend more than 8.5% of their income on health insurance.
Lisa: OK, so Biden’s plan expands coverage and it offers subsidies. How does Biden say he’ll pay for all of that?
Ervin: Well the official price tag for the plan is $750 billion over 10 years. The Biden campaign says it will pay for that by raising taxes on those earning more than $400,000 a year, and by negotiating down costs.
Worf: Has anyone checked those numbers?
Ervin: Yes, but like all campaign plans, there really aren’t enough details right now to do a good number crunch. The nonpartisan Committee for a Responsible Federal Budget reviewed the plan and says that depending on what the plan ends up including, Biden’s plan could reduce the deficit by $250 billion or add to it by $1.3 trillion.
Worf: You said Biden’s plan includes ways to cut prescription drug prices. How does it do that?
Ervin: Biden says he’d cap U.S. drug prices – which cost roughly 80% more those in other developed countries—so they’re in line with international prices. And he’ll prohibit prices from rising faster than the rate of inflation.
He also wants to authorize the federal government to negotiate with manufacturers. Right now that’s prohibited by law.
I talked with a senior adviser to the Biden campaign, Julie Chávez Rodriguez. Here’s what she had to say:
Julie Chávez Rodriguez: “Joe Biden believes that it’s sort of unfathomable that at this point pharmaceutical companies are not forced to negotiate with Medicare to be able to lower drug prices, that other countries are paying less for the same drugs and pharmaceuticals that we’re paying here in the United States.”
Worf: It seems like we’ve been hearing about negotiating with drug companies for years, though. What’s the chance that’s actually going to happen?
Ervin: Look, drug prices are a big issue for a lot of people right now. And both the Biden and the Trump campaigns have focused on that. So there could be more momentum behind this now.
Worf: OK, so how feasible is any of this? I mean, the Biden plan really expands on the Affordable Care Act, and the Supreme Court could decide to strike down the law. What happens then?
Ervin: According to some experts, Democrats could still preserve the law if the Supreme Court strikes it down. I talked to Cynthia Cox, the vice president of the nonpartisan health policy organization, the Kaiser Family Foundation, about that. She says it depends on which party controls Congress.
Cynthia Cox: "If Democrats were in control of Congress and the presidency, its pretty clear that there are some legislative ways in which the Affordable Care Act could be preserved even if the court overturns it, initially. The question before the court now is whether the ACA is constitutional without an individual mandate penalty. So, one solution there for Democrats would be to increase the penalty to $1, $15, $50, you know, even some small amount."
Worf: If Biden is elected, how much of the plan can he really implement?
Ervin: Well, that depends. If Congress remains closely divided, probably not that much. Remember, it took 60 votes in the Senate to pass the Affordable Care Act — with all the Democrats voting for it and almost all Republicans voting against it.
So what the Biden campaign wants to do and what are achievable may be very different.
