Trump and Clinton have similar ObamaCare results

The Affordable Care Act (ACA), or ObamaCare, is no doubt controversial and will certainly change depending on the results of the upcoming election.  The candidates have vastly different perspectives on the role and responsibility of government in the administration of healthcare.  

Should there be a mandate for coverage? Should non-residents have access? Should the ACA be repealed entirely? One area where both parties agree is the prohibition of coverage denials based on pre-existing conditions.

{mosads}Without this provision many million Americans who do not receive employer-based health insurance are virtually uninsurable because of any one of 400 medical conditions, and filling this large gap in our healthcare landscape has been a major victory of recent healthcare reform.

Though the two parties plans on how to accomplish this seem very different on the surface, their end result is surprisingly similar.

Most people agree that the healthcare exchanges, as they exist now, are not working well. Not enough young healthy people have enrolled to offset the cost of older, sicker patients who are more costly to insure.

This has resulted in expensive plans with poor benefits and narrow networks; premiums are set to rise 27 percent next year, and only 57 percent of physicians surveyed are planning to accept new patients. And despite these rising premiums, and the fact that 85 percent of enrollees receive federal subsidies, multiple commercial carriers are pulling their plans from marketplaces because they are insolvent

If Donald Trump wins the presidency his goal is to repeal the ACA. He and other members of the Republican leadership have vowed, however, to keep intact the provision against coverage denials for pre-existing conditions.

They propose to do this with additional funding to expand Medicaid at the state level, which would absorb the otherwise uninsurable, high-cost patients. Obviously Medicaid plans are not the best our system is capable of — networks are narrow, benefits are limited, and the quality of care is often not the greatest. Well managed privately administered Medicaid plans do an excellent job, however, of ensuring a standard of health to the millions of Americans who qualify for it, and do it relatively cost-effectively.

The best study to date puts Medicaid’s price tag at $62,000 per quality-adjusted life year gained, which is on par with other commonly offered health services.

If Hillary Clinton gets elected she plans to infuse more federal funding into the current marketplace system to save and stabilize it. In order to reduce costs there will likely be some combination of limitation of covered services, narrowing of networks, and poorer quality of care as reimbursements to physicians and facilities are reduced. Sound familiar?

Over time the surviving ObamaCare plans will more closely resemble managed Medicaid – benefits won’t be ideal but the plans will ensure coverage to those without a better option, with the federal government paying the bill.

Guaranteeing coverage to people with pre-existing conditions fills an important void in our healthcare system and ensures many millions of Americans no longer end up bankrupt by their health.  In addition our economy becomes more dynamic as workers are encouraged to take risks and move into better fitting jobs without fear of the catastrophic repercussions of losing their employer-based coverage.  And though the plans floated by the two parties seem unalike, I predict they’ll play out similarly over the next several years.