By Elise Aliotti
Policy Intern - AMCHP
In anticipation of the upcoming presidential election and change in administration, the Republican and Democratic parties have released their blueprints for improving the nation’s health care system. The Democratic plan would expand the Affordable Care Act, while the Republican plan would scale it back. The two party platforms express differing visions for the country, and each would have lasting effects on maternal and child health services.
The Republican Plan
Republican leaders’ plan, “A Better Way,” outlines the party’s recommendations to improve health care delivery, payment and coverage by changing the ACA. Its proposals include removing the requirement for insurers to cover essential health benefits and repealing the health care law’s individual mandate. The plan retains the provision allowing children to stay on their parents’ insurance plans until age 26 as well as the ban on lifetime coverage limits.
The Republican plan allows states to choose from two options for their Medicaid programs: a block grant or a per capita allotment approach. States that have not expanded Medicaid would no longer have the option to do so. Each state would be allowed to determine which subsets of its population would be eligible for Medicaid coverage and which services would be covered, although coverage for certain vulnerable populations would remain. States would also be permitted to impose work or education requirements on adult enrollees and use wait lists or premiums for people who want coverage but do not fall into the category of people for whom coverage is mandated.
The plan would no longer require insurers to meet minimum coverage requirements, which could lead to underinsurance for individuals and families who purchase less expensive plans that have limited benefits. Without minimum coverage requirements, insurance companies could opt out of covering certain preventive care measures for mothers and children.
The GOP plan proposes a one-time opportunity for people to obtain insurance in the individual market with a guarantee of coverage regardless of pre-existing conditions. If an individual does not enroll in coverage during this open enrollment period, insurers could determine eligibility and premium costs based on the individual’s pre-existing conditions.
The Children’s Health Insurance Program (CHIP) would also undergo changes. The Republican plan would eliminate the ACA’s enhanced 23 percent federal match for CHIP, returning to a match rate in the traditional range of 65 percent to 85 percent.
The Democratic Plan
The Democratic Party platform, released in July, does not call for as many significant changes, focusing instead on expanding the reach of the ACA. The platform promotes the adoption of the ACA’s Medicaid expansion in all states and recommends allowing individuals and families to purchase health insurance on the ACA health exchanges regardless of their immigration status.
The Democratic plan reaffirms the provisions within the ACA that ensure women have access to preventative care and contraception with no copayment or coinsurance. The platform includes measures to improve treatment for mental illness and substance abuse, including school-based prevention programs for adolescents. In addition, the platform pushes for autism screening in early childhood and requiring insurance companies to cover autism treatment services. Another provision would double funding for federally-qualified community health centers and provide workforce training to improve quality of care and access to care.