Thrive by IU Health

October 27, 2020

3 Healthcare Topics Every Hoosier Should Know About Before They Vote

3 Healthcare Topics Every Hoosier Should Know About Before They Vote

As we approach Election Day on Tuesday, Nov. 3, healthcare continues to rank high on just about everyone’s list of critical questions for our political leaders. We understand how hard it can be to follow these issues, which range from the future of the Affordable Care Act to prescription drug costs.

We’ve compiled a quick guide to some of the top healthcare issues under discussion to keep you informed on these key public policy matters before you vote.

1. How could the election change the Affordable Care Act (Obamacare)?

The Republican and Democrat political parties take very different approaches to the Affordable Care Act (ACA), sometimes called Obamacare.

The ACA was one of the most important pieces of health legislation of the past 50 years. Among other provisions, the ACA significantly expanded Americans’ access to health insurance by allowing states to offer Medicaid to more low-income citizens and by providing tax credits and subsidies to qualifying individuals and families when they purchase private insurance plans. The ACA also requires insurance companies to guarantee basic types of coverage in their insurance plans, including coverage for people with pre-existing conditions (chronic health conditions you’ve already received care for).

This year’s election could prove the deciding factor in whether the ACA stays in place or is repealed.

President Donald Trump and the Republicans have called for the ACA to be repealed and replaced with a better plan, although they have not provided many details on what such a plan would look like. Democrats, led by former Vice President Joe Biden, want to build on and broaden the ACA by expanding tax credits to make insurance premiums affordable for more people. They also want to offer a government-backed and more likely less expensive alternative to private insurance plans available through employers.

Since the enactment of the ACA, the number of Hoosiers without health insurance coverage has been reduced. Before the ACA, 14.8% of our residents were uninsured. By 2016, that number had dropped to 9.6%. In 2018, it was at 8.3% — a decline that was largely attributable to Indiana’s decision to expand Medicaid in a uniquely Hoosier manner.

Indiana created a program called HIP 2.0, which provided more low-income individuals and families with health insurance coverage, but also encourages them to be cost-conscious consumers by creating a type of health savings account they must use to pay a portion of their medical expenses.

2. How will the parties address rising drug costs?

No doubt, the costs of prescription drugs have grown faster than Hoosiers’ incomes. In 2007, individuals spent an average of $738 on prescription medicine every year — an amount that will rise to nearly $1,635 in 2027. That’s an increase of 120% over two decades, and it’s why drug pricing is a top issue in the election, whether people lean politically left or right.

Republicans and Democrats agree that people pay too much for many medications, and both presidential candidates say they are working on plans to reduce drug costs. Trump has issued several executive orders aimed at lowering drug prices, but many of those provisions have yet to be implemented. Biden wants to use the government’s power as a huge purchaser of Rx drugs through Medicare and Medicaid to negotiate lower prices for drugs in these programs.

In the meantime, IU Health works continually to address rising costs and find solutions for Hoosiers. When providing care to our patients, we consider a medication’s price, its effectiveness, and whether there are other options.

3. Both parties want to get rid of “surprise billing.” How will they do it?

Surprise billing refers to the unpleasant surprise of getting a healthcare bill that’s much higher than expected. Generally, it happens when you receive emergency or hospital care from a provider who isn’t in your health insurance plan’s provider network. About 10% of emergency bills include out-of-network charges. And at the time, you might not even know you’re receiving out-of-network care — or have a choice.

Both political parties are working to eliminate these bills. Trump has issued an executive order preventing surprise bills for COVID-19 care, and his positions have included calling for “price transparency” for healthcare. Biden’s plan would bar healthcare providers from charging out-of-network rates when patients don’t have control over which provider they see (for example, during a hospitalization). But while Congress has considered legislation, several pending bills are still being negotiated.

During its last session, the Indiana General Assembly passed a number of bills on important healthcare issues. The legislation covered:

  • Good faith estimates: For any procedure scheduled at least five days in advance, a provider must give a good faith estimate. This estimate tells you the allowed amount under your insurance. Your payment might vary based on your specific plan.
  • Surprise billing: Legislators tried to prevent surprise billing, but expect the Assembly to revisit and revise the law’s language in the coming session, given some inconsistencies in the legislation.
  • Posting of shoppable services: Effective March 31 of next year, hospitals and ambulatory surgical centers must post on their websites 70 shoppable services specified by the Centers for Medicare and Medicaid Services (CMS). They also must post 30 other “most common” services, using a specified format for both types.

Additional resources

Learn more about healthcare issues and factors affecting the cost of healthcare in a report commissioned this year by the Richard M. Fairbanks School of Public Health at IUPUI: Addressing Factors that Affect Health Care Costs: Recommendations for Indiana Stakeholders.