The ACA’s protections for preexisting conditions are popular across Democrats, Republicans, and Independents – majorities across parties do NOT want to see these protections overturned by SCOTUS.

BUT pre-ex protections make insurance more expensive.

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2/ How to balance protecting pre-ex and the resulting high premiums? Political discourse has centered on subsidizing more vs covering less:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">Biden would https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben">subsidies
https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">Trump would https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten">coverage

A third lever – addressing the underlying cost of care – has gotten less attention

3/ Biden’s plan to increase subsidies would lower premiums for virtually everyone buying their own coverage, and would lower costs for another 12.3 million people with employer coverage.

The tradeoff: Expanding subsidies would cost taxpayers money https://www.kff.org/health-reform/issue-brief/affordability-in-the-aca-marketplace-under-a-proposal-like-joe-bidens-health-plan/">https://www.kff.org/health-re...

4/ Trump hasn’t shared a plan to cover pre-ex if ACA overturned, but his record of Repeal & Replace and short term plans suggests he would lower premiums & gov costs by reducing benefits.

Tradeoffs: Weakened pre-ex protections, higher OOP costs for the sick, more uninsured.

5/ Democrats& #39; desire to boost subsidies and Republicans& #39; efforts to decrease the scope of coverage merely shift costs between individuals/taxpayers and healthy/sick.

Shifting costs doesn& #39;t curb underlying high health costs (hospitals, doctors, pharma) https://www.healthsystemtracker.org/brief/what-drives-health-spending-in-the-u-s-compared-to-other-countries/">https://www.healthsystemtracker.org/brief/wha...

6/ To address the underlying cost of care, Trump has proposed some policies aimed at lowering drug prices, but many of his more ambitious plans have been met with legal challenges or were just never implemented. He also supports price transparency, but evidence is mixed.

7/ In addition to addressing drug costs more aggressively, Biden says he would lower costs through a public option, which could save $ by paying providers less. It would also be available to people with employer coverage

But provider groups will mount strong political opposition

8/ These 3 levers – subsidizing more, covering less, and addressing underlying costs – are not mutually exclusive and exist in other countries.

If we lower healthcare prices, the U.S. could get more affordable comprehensive insurance, maybe even with less government spending.