Trump vs Biden compare on key healthcare issues

Trump vs. Biden: Background on healthcare

While Affordable Care Act (ACA) alternatives and a “public option” are the primary healthcare issues at hand, both candidates are also suggesting incremental measures to end surprise medical billing, require price transparency and further reduce the cost of prescription drugs and health insurance premiums. However, depending on how the 33 available seats in the U.S. Senate are filled, as well as the potential use of the filibuster, either candidate could be faced with health policy gridlock in the years ahead.

President Trump

Vice President Biden

Affordable Care Act
President Trump opposes the ACA, favored repeal attempts when Republicans controlled Congress, and supports the forthcoming challenge before the U.S. Supreme Court over its constitutionality. The court will hear arguments on November 10, 2020, with a decision to follow sometime in the first half of 2021.

Individual coverage health reimbursement arrangements (HRAs)
Under the Trump administration, the U.S. Department of Labor has created individual coverage HRAs that allow employers to provide funds to employees for separate coverage or other healthcare expenses, as opposed to providing coverage directly to satisfy ACA requirements. However, adoption has been slow because the individual market experience remains poor.

Affordable Care Act
Vice President Biden favors maintaining and expanding coverage under the ACA, where employers with 50+ full-time employees would still be required to offer ACA-compliant care, and employees would be allowed to seek coverage on the ACA exchanges.

Public options
Vice President Biden supports a public insurance option similar to Medicare that would be available on the ACA exchanges. This would compete with other qualified health plans in the event employees are incentivized to select the option over employer-provided coverage.

Medicare age
Vice President Biden wants to lower the eligibility age for Medicare to 60 from 65, with optional enrollment in that five-year period. This could potentially prompt more employees to retire sooner than they otherwise would.

Employer takeaways

Many legal analysts don’t believe the court will strike down the ACA, but if it does happen and/or pre-existing condition protections are weakened, there could be some uncertainty about what employers are compelled to cover.
While a low probability event given the inertia in Washington, widespread enrollment in a public option would pose significant challenges to private insurers, which would be competing against a federally subsidized program.