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What's At Stake In The U.S. Health Care Debate?


We're going to go back now to one of this country's major challenges - its health. Coronavirus cases continue to surge across the country. On Friday, the U.S. set a new single-day record of at least 83,000 confirmed infections - that according to Johns Hopkins University. Some of the worst outbreaks are happening now in the West and Midwest. And on Saturday, six states - Alaska, Ohio, Oklahoma, Colorado, New Mexico and Illinois - reported their highest-ever number of infections.

And this latest spike in cases comes only nine days ahead of the election. And it also comes just over two weeks before the Supreme Court is set to hear a case that could repeal all or part of the Affordable Care Act. So we wanted to take a closer look at the debate over health care policy in this country. And to do that, we've called Julie Rovner once again. She is the chief Washington correspondent for Kaiser Health News and host of the podcast "What The Health?"

Julie Rovner, thanks so much for being with us once again.


MARTIN: So, as we mentioned, we're in the middle of a surge of cases in the U.S., but the economic downturn caused by efforts to deal with the coronavirus has also meant that millions of people have lost their jobs, and with that, they've lost their private health care coverage. So we were wondering if the pandemic has shifted or changed public opinion about health care policy. Has it elevated it in some way?

ROVNER: You know, not that we've seen. And, in fact, what we've seen from opinion polls is that sort of health care in general has dropped on the public's list of things there they really want and expect from the government, even as coronavirus and dealing with the coronavirus has risen. It's now the No. 1 health topic that voters want addressed. I believe it's the No. 1 topic that voters want addressed.

MARTIN: Going to the presidential candidates now, can you just give us a sense of what each candidate's health care policy platforms are? I mean, recognizing that the Republicans didn't really adopt a platform this year - but just - can you just sort of enumerate what each party's stance is based on their record and based on their platform, if it exists?

ROVNER: So former Vice President Biden came out with his health care plan in the summer of 2019. He has a plan that would build on the Affordable Care Act. It would expand it in a fairly dramatic way. It's just it looks very moderate compared to "Medicare for All." And he's been running on that, and he has not really wavered from that.

President Trump, of course, has been promising us a health care plan since before he was elected. We have yet to see it. In September, the president did come out with what he was calling the America First Health Plan. But it really isn't a plan. It's kind of a press release of some of the sort of smaller health care things that he has done and kind of vague promises for what he might do in the future. So we still don't know exactly what President Trump would do if the court strikes down the Affordable Care Act.

MARTIN: Former Vice President Joe Biden says he would build on the Affordable Care Act. Has he said how? Like, what are some of the innovations or tweaks that he would hope to present?

ROVNER: Yes, he wants to create a public option. This would be sort of Medicare for all who want it that people could buy. If they buy their own insurance on the individual market, they could buy a Medicare-like government-sponsored plan. For people in states that have not expanded the Medicaid program, those - some of those people would be automatically enrolled. And even people who have employer insurance but don't like it or feel like they can't afford it would be able to buy into this public option, at least as Joe Biden envisions it.

He would also make financial subsidies available to more people who buy their own insurance on the marketplaces under the ACA. People wouldn't have as many out-of-pocket costs that go with their insurance. That's a big problem with the current Affordable Care Act plans, is that you can buy insurance, but then you have a $7,000 deductible, which most people can't possibly pay.

MARTIN: And on November 10, as we said, the Supreme Court is set to hear oral arguments in a case seeking to overturn the Affordable Care Act. What exactly is at stake here? And how has Judge Amy Coney Barrett's nomination to the Supreme Court affected possible outcomes of the case? Because certainly, that is another argument that people on both sides are making.

ROVNER: Yes, it very much is. This is a lawsuit that was brought in 2018 by a group of Republican attorneys general and a couple of governors, charging that by eliminating the tax penalty for not having insurance in the 2017 tax bill, Republicans either inadvertently or on purpose made the entire Affordable Care Act unconstitutional.

Most Supreme Court and health experts think it's not a very strong case, that it's not nearly as strong as two previous cases before the court that the court said, no, the Affordable Care Act really is constitutional. And Chief Justice Roberts was part of the majority in both those cases. So the theory was, yeah, this case was going to get to the Supreme Court, but the Supreme Court was going to shoot it down.

Well, now if Amy Coney Barrett gets onto the bench, Chief Justice Roberts' vote might not matter. So there is some more concern that the entire law could be struck down, although most people still think that's not entirely likely to happen.

MARTIN: And if the law is overturned, you know, what does that mean for those who depend on the ACA? I mean, do people immediately lose their insurance? What would happen?

ROVNER: Nothing good. I mean, it's more than just - there's about 20 million people who get their insurance directly as a result of the Affordable Care Act. They wouldn't technically lose their insurance, but the money would immediately stop. So they would probably lose their subsidies if they're buying their own insurance, which would make their insurance unaffordable.

And on Medicaid, the states would then have to pick up the 90% of the cost that the federal government is now providing. And most states and clearly in the middle of a pandemic wouldn't have the wherewithal to do that. Plus, the Affordable Care Act is much broader than just sort of those two pieces of it, and it could really wreak havoc on the rest of the health care system.

MARTIN: That is Julie Rovner, chief Washington correspondent for Kaiser Health News and host of the What The Health?" Podcast.

Julie Rovner, thank you so much for talking with us.

ROVNER: Thank you for having me. Transcript provided by NPR, Copyright NPR.