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Improving Affordability for the Middle Class: Clinton vs Trump

This article explores the differences between Clinton and Trump's messages on the middle class burden of healthcare costs and how their policies could impact affordability. It also discusses the challenges faced by the middle class and potential solutions.

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Improving Affordability for the Middle Class: Clinton vs Trump

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  1. “I want to save the middle class.” “I believe America thrives when the middle class thrives.” Clinton, Trump Present Starkly Different Messages On The Middle Class Burden of Health Care Costs Moves to the Middle Class

  2. Three Takeaways Insurance premiums have risen only modestly under the ACA for many in the middle class. But affordability remains elusive for some in the middle class because of higher deductibles and rising overall health care expenditures. Trump Administration policies could help—or hinder—efforts to improve affordability for the middle class.

  3. Who is the Middle Class?

  4. Defining the Middle Class by FPL (139-400%)

  5. Who is the Middle Class?

  6. Where Does the Middle Class Live?

  7. Affordability on the Individual Market:Subsidies are Critical

  8. Affordability for the ESI Market:Employee Premiums Have Grown only Modestly

  9. Affordability: It’s Complicated • Subsidies • Essential Health Benefits • Pre-existing Conditions (if you’re healthy) • Pre-existing Conditions (if you’re sick) • Employer Mandate • (deductibles) • Employer Mandate (premiums)

  10. Remaining Challenge: High Deductibles

  11. Remaining Challenge: Rising Overall Health Care Expenditures

  12. A Look Ahead: How Might Trump Administration Policies Affect Affordability for the Middle Class?

  13. A Look Ahead: How Might Trump Administration Policies Affect Affordability for the Middle Class?

  14. A Look Ahead: What Might be Some of the Debates in Colorado? High cost areas? Age rating? Essential health benefits? Helping consumers make decisions? Moving costs vs. controlling costs

  15. Three Takeaways Insurance premiums have risen only modestly under the ACA for many in the middle class. But affordability remains elusive for some in the middle class because of higher deductibles and rising overall health care expenditures. Trump Administration policies could help—or hinder—efforts to improve affordability for the middle class.

  16. Affordability in Summit County Strong Families. Strong Community. www.summitfirc.org

  17. Tough Choices:What Unaffordable Health Care Means for the Middle Class • “I had to choose between helping my child attend college or paying for health insurance.” • “The cost of health insurance is ridiculous in Summit County. I’ve made my budget work here for 15 years and now I’m going to have to move to Denver for lower rates.”

  18. Tough Choices:What Unaffordable Health Care Means for the Middle Class • “My child was sick and I felt like she needed to go to the doctor, but I had already used my two visits for the year, so I had to watch her suffer because I couldn’t afford the $200 doctor visit.” • “I had to leave the doctor I’ve been seeing for the last 20 years when I got on Kaiser’s plan. Now I see a different doctor every time and I feel like a stranger in my own town.”

  19. Middle Class Challenges Families who have always used private plans are now facing the following because of high regional rates and the plans offered in the Marketplace: • No longer affordable • Limited provider choices • High deductibles and out-of-pocket max • More stress and less healthcare

  20. The Colorado Variable – Cost of Living

  21. $98,000 (above 400% FPL) Cheapest Bronze Plan • Kaiser • 2 office visits per person

  22. $55,000 (250% FPL) Silver Plan • Kaiser • 2 kids on CHP+ • OPM = 5% income ($2,750)

  23. $98,000 (above 400% FPL) Silver Plan

  24. Impacts of High Deductible Insurance: Most people are paying for low quality plans and opting to not seek care because of the deductibles. Children on these plans are not getting as good of care as children on CHP+ because parents opt to not seek care unless it’s an emergency.

  25. On the Edge: Life above 400% FPL Little room for people to qualify for subsidies Summit County $81,000 $97,000 Tax subsides make a significant difference in being able to afford health insurance. Median income 400% FPL Colorado Springs $71,000 $97,000

  26. Moving Forward Underlying cost issues must be addressed Geographic disparities must be studied More flexibility for states to try new ideas (New Maryland All Payer Waiver) Creation of and more support for local micro-networks Expand possibility for purchasing pools –create local options Premium Assistance pilots Establishing geographic area rate banding where a geographic area’s factor must be within plus or minus [X]% of state average

  27. Edmond Toytoye @coloradohealthinstitute.org

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