What Might the 2016 Election Hold for the Future of the Affordable Care Act?

The U.S. presidential primary season is in full swing, and, as seen throughout the debates, the Patient Protection and Affordable Care Act of 2010 (ACA) is among the top domestic issues addressed by the presidential candidates as they seek to become the next Commander in Chief. Given the candidates' statements on the ACA, it seems clear that, regardless of which political party next occupies the White House, the ACA is in for some degree of change, whether small or sweeping. What is less clear is each candidate's vision of what exactly would replace the ACA. This article will examine how the candidates' recently stated views may impact the ACA during the next presidential term from the stance of an objective third-party.

The ACA is a prime example of an issue where the differences in opinions among the candidates are extreme. Those favorable to the ACA view access to health care as a fundamental right, and point to the increased number of Americans who now have access to health care. To them, a system of national health care managed by the Federal Government is seen as necessary to ensure that the most vulnerable members of society, such as the poor, the aged, and the chronically ill, have access to the care they need. Those who oppose the ACA deny its constitutionality, particularly the mandate that all Americans participate, and contend that it has resulted in higher costs, limited choice, and poorer quality of care. These opponents believe that, as with other sectors of the economy, the role of the Federal Government should be minimized, and that greater efficiency and true cost reduction can be achieved via free-market principles.¹ 

This stark contrast in ACA viewpoints tends to break down along party lines. The Democratic candidates view the ACA in a positive light:

• Hillary Clinton vows to "continue to defend the Affordable Care Act against Republican efforts to repeal it."²
• Bernie Sanders was a member of the U.S. Senate committee that wrote the Affordable Care Act.³

Despite their support, Democrats Clinton and Sanders do not consider the ACA to be a final solution to health care reform. Clinton proposes revisions to the ACA, the objectives of which are expanded coverage, lower health care costs, and improved value and quality of care.⁴ Sanders discusses even more dramatic change: universal health care, a federally administered single-payer health care program providing comprehensive coverage for all Americans.⁵ In their debates, Clinton and Sanders have challenged the feasibility and costs of their respective proposals.

The Republican candidates are unanimous in their disregard for the ACA, most commonly referred to by the colloquialism, "ObamaCare:"

• Donald Trump claims, "[T]he one thing we have to do is repeal and replace ObamaCare."⁶
• Ted Cruz says "[T]here’s no greater regulatory reform than repealing every word of ObamaCare."⁷
• Marco Rubio states he is "[c]ommitted to fully repealing ObamaCare . . . Ending this failed law will be an urgent priority of his administration."⁸
• John Kasich claims that, "Everyone knows that ObamaCare must be repealed and replaced with something that actually works in line with America's market-based principles to help Americans be healthy."⁹

Although united in their opposition to the ACA, the Republican candidates offer alternative solutions that vary in both emphasis and detail. Despite professing his opposition to the ACA, Trump's plan for health care reform is elusive; at times he has espoused free-market principles while at others he appears to have embraced universal health care.¹⁰ Cruz believes, "[W]e need to enact reforms that make health care personal, portable, and affordable. Specifically, we need [to] open insurance markets across state lines, expand Health Savings Accounts, and delink health insurance from employment."¹¹ Rubio has stated that, "America needs health care reform that will cut back government's role and harness the forces of competition to keep health care prices low and spur innovation. That means not just repealing ObamaCare, but replacing it with a market-driven alternative and reforming Medicare and Medicaid for the 21st Century."¹² Kasich proposes a plan modeled after reforms he introduced in Ohio, which would reduce costs by improving primary patient care and mandating coordination among providers to control costs and maximize quality to reduce the rate of high-cost episodic care.¹³ 

Voters, health care providers, and insurers alike will be impacted by either an expansion or an outright repeal of the ACA. All would be wise to keep a wary eye as the candidates continue to set forth their vision for a post-election healthcare landscape.


¹ 2016.presidential-candidate.org/health-care
² hillaryclinton.com
³ berniesanders.com
⁴ hillaryclinton.com
⁵ berniesanders.com
⁶ ontheissues.org, citing, ABC News This Week 2015 interview by Martha Raddatz.
⁷ tedcruz.org
⁸ marcorubio.com
⁹ johnkasich.com
¹⁰ ballotpedia.org/2016_presidential_candidates_on_healthcare
¹¹ tedcruz.org
¹² marcorubio.com
¹³ johnkasich.com