by Professor Amit Patel
Department of Public Policy and Public Affairs
For a while during the second presidential debate, it seemed like policy issues might never come up and the evening will only be dedicated to various scandals: Bill Clinton’s infidelities, Hillary Clinton’s emails and, the now-infamous Donald Trump video that had dominated headlines just before the debate night. Thankfully, in this town hall-style debate format, one of the members asked a question on a specific policy – Affordable Care Act (ACA), aka Obamacare.
The debate over Obamacare — much like the American health care system itself—is far too complex to cover in a few minutes. But in the simplest terms, the U.S. health insurance system after the passage of President Obama’s signature health law has succeeded in its goal of bringing health insurance to millions of Americans who didn’t previously have it. It has certainly not achieved universal coverage; some 29 million Americans remain uncovered, and it has not succeeded in bringing down health care spending overall or made it affordable to many Americans. It is definitely a work in progress and it is wise to bring it up in this election as a salient policy issue.
Clinton acknowledged those problems upfront and pledged to address them. More importantly, she reminded Americans about parts of the law that people actually like: probation on insurance companies from denying coverage to patients with pre-existing conditions, allowing young adults up to age 26 to stay on their parents’ insurance plans, and no discrimination due to gender in insurance premiums. While Clinton might want to come up with a different system, as she once mentioned, she acknowledged that it makes more sense to fix it than to start over. Much like Obamacare, Clinton proposes an incremental approach to policy that builds on our existing employer-based system, as opposed to a completely different policy idea such as a single payer healthcare system.
Trump, by contrast, said Obamacare is beyond fixing and should be fully repealed. Anyone with some political acumen could say that repealing it is not even possible or feasible at this point. After the passage of Obamacare, there have been many symbolic efforts to repeal parts of Obamacare in the past but the Republican nominee vowed to replace Obamacare with a better system. While Trump did not provide any details on what that better system might be except one specific proposal: to get rid of the artificial state lines to allow companies to sell insurance across state lines. In theory, this long-standing proposal by the Republicans (and not an original Trump idea) will boost the competition and lower the cost. However, the real barrier to interstate insurance sales is the difficulty of setting up hospital networks in new areas rather than regulation alone.
Repealing Obamacare, as Trump has suggested, would bring us back to where we were before Obamacare. Not good (if I could borrow his phrase). At least, Clinton has proposed an incremental approach that would keep the parts from Obamacare that are functioning (related to increasing coverage) and fix the ones that need attention (related to curbing the healthcare costs).
Amit Patel (PhD, George Mason University) is an assistant professor of public policy and public affairs at UMass Boston’s McCormack Graduate School. His research focuses on bottom-up approaches to improve socio-economic outcomes for the urban poor and has been funded by the National Science Foundation and Melinda and Bill Gates Foundation.