It’s easy to see why the vast majority of American voters say health care is one of their top priorities. Our system is plagued with exorbitant out of pocket costs, skyrocketing profits for pharmaceutical and insurance companies, a rising uninsurance rate, unequal access, and inadequate funding for mental health and substance abuse disorder services. 

Now that we’re living in a pandemic, we’ve jumped from the frying pan into the fire. The recession jump started by COVID brought into sharp relief the unsustainability of a system that ties health insurance to jobs – as unemployment skyrocketed this year, our uninsurance rate soared, peaking at a whopping 13 percent in May. 

Voters worried about health care affordability – or a lack thereof – long before “COVID-19” was a phrase on anyone’s lips. A study from early 2020 conducted by the Commonwealth Fund revealed that nearly four of every five voters think that reducing health care premiums and out of pocket costs should be top priorities for whoever wins the presidential election. 

Regardless of what happens at the federal level, states play a key role in investing in health care and expanding access. But the presidential election has major implications for our work in Washington – and how many hurdles we’ll have to overcome to ensure affordable coverage for all. 

Washington voters need to know: Where do our presidential nominees and Congressional candidates stand on health care – and what are the implications for our health care reform efforts here in Washington?

Depending on who wins in November, we’ll see one of two approaches to our nation’s health care plan. In short, Trump aims to continue to dismantle Obamacare or the Affordable Care Act (ACA) and further privatize the health insurance industry. That would threaten coverage for the 12.5 million people who have gained it under the ACA. In contrast, Biden wants to build on both the ACA and Medicare to expand subsidies and affordable access to care.

So far the Trump administration has slashed the marketing budget for federally subsidized health insurance by 90 percent, eliminated federal subsidies to insurance companies for cost-sharing reductions (which were designed to make insurance more affordable for low- and middle-income consumers), and is dead set on getting the ACA thrown out in court. The Trump Administration has also tried to add a work-requirement for Medicaid recipients, but that has been struck down in court as contrary to the program’s mission to provide care for people living in poverty. 

If re-elected, Trump will continue to advance his health policy proposals to eliminate any financial assistance like tax credits or cost-sharing reductions to people who buy individual market coverage, as well as drastically reduce federal funding for states that expand Medicaid. Trump also wants to eliminate regulations on health insurance companies, thereby allowing companies to once again discriminate and charge more based on pre-existing conditions.

Democratic nominee Joe Biden’s health policy platform asserts a comprehensive plan to expand Obamacare and access to both Medicare and Medicaid. Biden’s plan focuses on filling gaps improving coverage for those currently left out. His plan includes: 

• Creating a Medicare-like public health insurance option that would be available to consumers including those who receive employer-based coverage or buy on the marketplace. In this system, the federal government would collect premiums and pay providers directly. Undocumented immigrants would be allowed to purchase the public option, but not receive subsidies.
• Expanding premium tax credits to ensure that no one spends more than 8.5 percent of their income on health care premiums and improving access to more generous plans by calculating tax credits based on gold level plans, instead of silver plans.
• Providing premium-free coverage to the 4.9 million Americans who are currently left out of Medicaid coverage due to their state’s non-expansion status. Currently 12 states have not adopted Medicaid, leaving their low-income residents without affordable coverage. 

Biden’s health care plan will also drop the Medicare eligible age to 60 and control costs for everyone by stopping surprise billing and tackling out of control prescription drug prices. 

Whoever wins the presidency, a deeply partisan Congress will still have to pass major legislation in the face of intense industry lobbying to protect their wealth.

What’s at stake in Washington State

The federal election will play a large role in our ability to provide affordable, quality coverage for all in Washington State. Dismantling the Affordable Care Act without an alternative like Medicare for All could mean a loss in coverage for 775,000 people in Washington State and a $3.5 billion cut in federal health care funds. Other people at risk of losing their coverage include those who purchase their coverage through the state marketplace, young adults who receive coverage through their parents’ plans, and the 2.5 million American Indians and Alaska Natives who get their coverage through the U.S. Indian Health Service. 

A Biden presidency with a supportive House and Senate would likely improve access to affordable coverage for millions – but would still leave many systemic inequities in place. While making premiums more affordable helps people buy coverage, it does nothing if high deductibles and out of pocket costs prevent people from being able to use it. Leaving health insurance tied to employment means people are unprotected during times of economic recession, like the one we’re facing now. Retaining health insurance companies as central to the system means health care will continue to be treated as a commodity, not a right. And undocumented people will still be left unsubsidized.

Regardless of the federal election, Washington State has an obligation – and tremendous power – to improve health care affordability.

We can increase premium subsidies, expand cost-sharing reductions, and ensure coverage for undocumented people, who are now barred by the federal government from participating in our state’s marketplace. We can tax health insurance companies to redirect their soaring profits to low-income health insurance programs and foundational public health (instead of CEO and investor pocket books). And we can look to health care transformation, like the universal health care models being considered by our state’s Universal Health Care Work Group. 

Any way you slice it, Washington State is primed to help lead the nation in demonstrating that health care is not a commodity, but a human right.