President Barack Obama’s Patient Protection and Affordable Care Act has been one of the most contentious laws enacted in recent memory. While the president and his party has lauded ACA for insuring millions of previously uninsured, his political adversaries have criticized it for adding to the national debt, offering limited financial security and overburdening an already fragile health care system. The presidential candidates have yet to make ACA a major election issue, but that could change once the party nominations are finalized.
For most of the past eight years, both parties have been involved in a political brawl over ACA. In the latest salvo, the first action of the Republican controlled U.S. House of Representatives in 2016 was to send a bill repealing Obamacare. This was a token effort—immediately vetoed by the president—but it suggests the continuing antipathy towards ACA among the electorate and political establishment. It follows two major Supreme Court cases and legislative actions which failed to halt the program. With millions of Americans insured through Healthcare.gov, it appears unlikely that ACA can be undone without executive action.
For many ACA opponents, their final hope is placing a Republican president in office. Should one of the GOP candidates attain the highest office, it would still be a challenging political fight to significantly modify ACA. Although 35 percent of voters support a repeal or GOP replacement program, most Americans support the health insurance marketplaces and Medicaid expansions. Furthermore, major players like the insurance industry remain generally supportive of the policy.
Despite the challenges inherent in overturning such a major law that much of the country has embraced, many of the leading presidential candidates have voiced their desire to repeal or modify ACA. The GOP frontrunner, Donald Trump has vehemently criticized Obamacare as a “complete disaster,” and has said that he will replace it with universal health coverage. Texas Senator Ted Cruz is virtually the spokesman for the anti-ACA lobby, having led efforts in Congress to defund the program. In recent weeks, however, his criticism of ACA has been tempered after enrolling himself and his family in the program that he hopes to repeal.
Perhaps the most detailed replacement plan is authored by former governor (and former GOP presidential candidate) Jeb Bush. His plan would maintain coverage for those currently enrolled through the health exchanges following the repeal of ACA. His replacement plan would also involve tax credits but would encourage employers to contribute to employee health coverage, limiting costs to policyholders. Bush would also eliminate the mandatory benefits, making it easier for insurers to offer policies.
On the other side of the aisle, leading Democratic candidate, Hillary Clinton, has strongly supported ACA and has campaigned on expanding it. She has criticized the rising deductibles charged by insurers and burgeoning prescription drug costs, insisting that she will cap both costs while also adding sick visits to physicians. While likely just campaign promises, if proposed, Clinton would likely find it difficult to convince insurers and providers to agree to such pricing limits.
Like Trump, Vermont Senator Bernie Sanders would like to see all Americans with affordable access to medical care. However, Sanders supports a single payer—i.e. the federal government—that would provide universal health care. If elected, Sen. Sanders would find it difficult to secure political support among his own party much less a Republican-controlled Congress.
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