In the second presidential debate, Hillary Clinton and Donald Trump offered different views on healthcare policy, and its most controversial subject, the Affordable Care Act.
As could be expected, debate moderator Anderson Cooper pressed Clinton on her husband Bill’s recent criticism of the ACA. As the L.A. Times reports, Bill Clinton called it a “crazy system” that works well for lower-income individuals or those who receive Medicare, but is forcing those who make too much to receive subsides to contend with shrinking coverage and spiking premiums. Trump had seized on those words, claiming Bill Clinton “torched” the ACA.
Clinton retorted during the debate that her husband “clarified what he meant,” but did not elaborate on that point. She acknowledged, though, that “premiums have gotten too high,” as have the costs of copays, deductibles and prescription drugs, noting she has proposed policies to address those issues.
But she also touted the law’s successes, including its role in 20 million people gaining some form of insurance. Even for those who don’t have coverage from ACA marketplaces, she noted, the law has helped them by ensuring women can’t be charged more than men, allowing individuals to stay on a parent’s plan until age 26 and banning coverage denials based on pre-existing conditions.
If the ACA were to be repealed, all those gains would be lost, she said, adding ”we will have to start all over again.”
That claim, according to an Associated Press fact check, is “essentially correct,” given that Congressional Republicans’ ACA replacement plan has not provided enough detail to accurately compare it with the existing law. Plus, a recent Urban Institute analysis showed Trump’s plan would increase the number of uninsured by about 20 million relative to Clinton's plan.
Trump, though, characterized the ACA as a “disaster,” arguing that the law’s provisions have become too expensive for both consumers and the government. One of his specific claims, though, that the ACA is “going to be one of the biggest line items very shortly” is vastly exaggerated, per another AP fact check. The Congressional Budget Office estimates the government will spend $110 billion this year on ACA coverage, far less than the estimated $590 billion it will spend on Medicare and $370 billion on Medicaid. Further, the ACA is projected to reduce the deficit, partially due to savings in Medicare, a Kaiser Family Foundation analysis showed.
The only solution, according to Trump, is to repeal the ACA, rather than what he said is the current administration’s tactic of asking Congress for more money. Clinton’s idea, he said, is to go to a single-payer plan--though the AP notes that it is Bernie Sanders, not Clinton, who backs such a system, even given Clinton's support for expanding the government's role in healthcare.
Anderson then pressed Trump, asking how he would force insurers to cover people with pre-existing conditions after repealing the ACA.
“You’re going to have plans that are so good, because we’re going to have so much competition in the insurance industry,” Trump said. One of the ways to create that competition, Trump said, is to sell insurance across state lines.
In fact, a recent research paper from Georgetown University assesses that idea, looking at three states that in the past two years have allowed in insurers from other states to sell products in their markets. The paper suggests the new policy had little effect: Likely due to the challenge of setting up provider networks, no out-of-state carriers have entered those states’ markets so far.