By Joseph Ax
(Reuters) – Healthcare, which has always been a top concern for U.S. voters, has become even more important in the face of a coronavirus pandemic that killed more than 205,000 Americans and cost millions of their jobs more.
The death of Liberal Supreme Court Justice Ruth Bader Ginsburg has meanwhile raised the stakes in the upcoming Obamacare litigation, officially known as the Affordable Care Act, as the Supreme Court hears the Trump administration's efforts to pass the law days after November repeal 3 choice.
Here's a look at some of the big health policy differences between Republican President Donald Trump and his Democratic challenger, former Vice President Joe Biden:
Trump has ceded much of the response to the pandemic to states rather than national efforts to expand testing, coordinate contact tracing, and purchase protective equipment in bulk. He has also sent mixed messages through masks that public health experts said were crucial in slowing the spread of the virus.
Since the spring, Trump has urged governors to reopen their states and urged public schools to return to face-to-face tuition on the grounds that "the cure cannot be worse than the disease". He has often downplayed the lethality of the virus and at times publicly undermined the experts in his administration.
Trump signed several aid bills that grossed trillions of dollars in individuals and corporations despite Congressional Democrats calling for more spending. The government also launched Operation Warp Speed to help develop a coronavirus vaccine.
Biden has vowed to "listen to the science" and even to say he would consider another national economic shutdown if experts recommend it. He has called for a national mask standard, although he has admitted that he may not be empowered to mandate their use.
His coronavirus plan provides for an expansion of tests and contact tracing and promises to appoint a "supply commander" to oversee the supply lines of critical equipment.
Biden has also proposed reopening insurance marketplaces to those who have lost insurance coverage through work, expanding paid sick leave, and increasing pay for frontline workers. He has questioned whether Trump could try to politicize the vaccination process in order to increase his own chances of re-election.
After years of failed attempts by Republican lawmakers to repeal the Affordable Care Act (ACA), Trump has turned to other tools to undermine the comprehensive health law: the executive and the courts.
The Justice Department supports a lawsuit by several Republican-led states trying to overthrow the entire ACA. This case is expected to be heard by the US Supreme Court on November 10th, a week after election day.
Justice Ginsburg's death has deepened concerns among Democrats that the court that previously upheld Law 5-4 in 2012 could rule against the ACA. Under the law, more than 20 million Americans have received insurance coverage.
The Trump administration has not proposed a comprehensive replacement despite Trump's pledges to provide a better, more affordable healthcare system. On Thursday he signed two executive orders under what he called “America First,” but they were seen as largely symbolic.
The Republican-backed 2017 Tax Review Act removed the ACA's individual mandate of most people being insured or fined. Experts say the move increased premiums.
Additionally, Trump has used executive power to promote short-term plans exempt from the ACA's obligation to cover basic benefits and provide cover for those with pre-existing conditions.
The Trump administration also cut funding for staff and advertising designed to help people navigate the ACA marketplaces, where individuals can get private insurance, often through government subsidies.
Biden has vowed to bolster the law passed during his first four-year tenure as Obama's vice president. His own health plan would cost $ 750 billion over 10 years and, according to his campaign, will be funded through tax increases for the rich.
Unlike some liberals, Biden does not support a deposit system like Medicare for All.
Instead, Biden's plan envisions a Medicare-like public option that would serve as an alternative, rather than a substitute, for private insurance.
In addition, tens of millions of people uninsured because they live in any of the 14 states that have refused to extend Medicaid – which covers low-income Americans – under the ACA would automatically be included in the public option. He has also suggested expanding the subsidies available on ACA marketplaces and limiting costs.
Trump has repeatedly stated that he will protect those with pre-existing conditions despite his administration's efforts to core the ACA.
On Thursday, he signed an executive order to maintain insurance coverage for those with pre-existing conditions in the event the Supreme Court overturns the ACA. But health experts immediately said the order had little practical relevance.
"The Executive Ordinance does not provide a specific guideline to protect people with pre-existing conditions, nor a path to such a guideline," said Larry Levitt, health policy expert at the Kaiser Family Foundation. "This is more of a small promise than a plan."
Trump's rhetoric on prescription drug prices was more hawkish than most Republicans, but his results were mixed.
In early September, he signed an ordinance to set Medicare prices for prescription drugs based on costs in other countries, where prices are often lower. However, experts say that order alone does not establish guidelines. The implementation of the change requires a lengthy regulatory process that is likely to be challenged by drug manufacturers in court.
Both Biden and Trump support some form of importing prescription drugs from overseas in an attempt to cut costs, although some experts have questioned whether this is feasible.
Trump also promised on Thursday to deliver $ 200 million cards to 33 million seniors to cover the cost of prescriptions, though it wasn't immediately clear where he would get the $ 6.6 billion from without Congressional approval.
Biden supports a bill approved by the Democratic-run House of Representatives last year that would allow Medicare to negotiate drug prices like private insurers.
Pharmaceutical industry-backed Republicans have argued that it would force drug makers to spend less on research and development, and the Trump administration has said it would veto the bill.
MEDICARE / MEDICAID EXPANSION
In April, Biden proposed lowering the Medicare registration age from 65 to 60 to appeal to liberal voters. Such a change would potentially expand Medicare to an additional 20 million Americans.
Trump has proposed several budgets that include cuts in spending on Medicare and Medicaid. According to Tricia Neuman, a Medicare expert at Kaiser, the Medicare cuts would not affect benefits but change the way providers are paid.
The administration has supported the imposition of work requirements and other restrictions on Medicaid eligibility, as well as the introduction of caps on the growth of Medicaid spending and the move from Medicaid to block grants – all actions that experts say would result in fewer people being insured are.
(Reporting by Joseph Ax; Editing by Colleen Jenkins and Jonathan Oatis)