There have been few pieces of legislation as controversial as the Patient Protection and Affordable Care Act during Barack Obama’s stint as President. While the Democrats have largely lined up behind it, the Republicans have criticized it, promised to repeal it and brought two major Supreme Court cases against it. ACA has withstood these challenges, and has helped insure an additional 8 million Americans through the newly established insurance marketplaces. More than 6 million were added to Medicaid through federally subsidized state expansions.
As a political issue, ACA continues to be a lightning rod for presidential candidates from both major parties. Republican frontrunner Donald Trump—in an interview with 60 Minutes—took an unusual stand on the law; he promised to repeal the law and replace it with a universal healthcare program. He points to rising premiums under ACA as the primary reason for its unfeasibility. Whether he actually implements a universal healthcare program or not, it is apparent that he understands that more access to healthcare is important to the American people.
Presumptive Democratic nominee Hilary Clinton has taken a slightly different position from Mr. Trump. Like Trump, she acknowledges that ACA insurance premiums and deductibles continue to rise at an accelerated pace. Although she does not promise to abolish ACA, she proposes a series of improvements like adding free doctors’ visits, raising tax subsidies and capping drug costs. She has not explained how she would pay for these changes. There are strong indications that Ms. Clinton is aware that voters are unhappy with many of the realities of the healthcare program, and is shying away from effusive praising it.
As both major parties are critical of President Obama’s flagship piece of legislation, there is little doubt that it should be a central issue of the election. Regardless of who wins the 2016 presidential election, it is virtually assured that the next President will propose changes. What exactly those changes will be are difficult to determine at this point.
Both candidates appear to be promising considerably more than they can deliver. While a complete repeal is possible, it is highly unlikely. According to a 2015 Gallup poll 47 percent of Americans approve of the Affordable Care Act, the highest since 2012. If ACA were abolished, almost 22 million Americans who obtained insurance through the exchanges would lose coverage. This suggests that Trump would be fighting strong political headwinds if he should try to scrap the new insurance marketplaces.
On the other hand, should Clinton attain the highest office, she would need one or both houses of Congress to implement any serious changes to the current law. While there is a slim possibility that control of either house could swing back into the Democrats’ hands, it would still remain politically untenable due to overwhelming Republican resistance.
It appears most likely that healthcare will remain a point of contention among the political candidates, one without any substantial solutions. While both sides will release a few talking points to secure minor political advantage, neither party is prepared to present concrete proposals that would improve the program.
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