JD Vance’s Health Plan Threatens ACA Protections

This story was originally published by The 19th.

JD Vance, the Republican vice presidential candidate, has proposed a controversial health care plan that could undermine key protections provided by the Affordable Care Act (ACA). Speaking at a recent event in North Carolina, Vance proposed that if elected, former President Donald Trump would modify health insurance regulations to favor healthier individuals, allowing them to access cheaper plans while those with chronic conditions or higher healthcare needs face different, and potentially more costly, options.

“That’s the biggest and most important thing that we have to change,” Vance stated, reinforcing his stance from a similar interview on Sunday. In the wake of last week’s presidential debate, Trump hinted at a new plan to replace the ACA, which expanded coverage for millions of Americans and implemented critical consumer protections, such as preventing discrimination against individuals with preexisting conditions.

While Vance claims Trump would uphold these vital protections, creating distinct insurance plans for different health statuses could effectively repeal them. The ACA established a unified health insurance risk pool, wherein individuals who require less care subsidize those who need more. This principle ensures equal premiums and deductibles among beneficiaries.

Vance’s proposed changes raise concerns about affordability for those with preexisting conditions. Experts note that separate risk pools could lead to significantly higher costs for those who are sicker. Without substantial federal subsidies for the targeted health plans, many individuals might find such coverage unaffordable.

The Trump campaign has not clarified whether subsidies would be part of this strategy. Additionally, it remains ambiguous how this plan aligns with Trump’s other health care promises, such as ensuring coverage for in vitro fertilization.

The implications of Vance’s proposal could be profound, particularly for women and transgender individuals, as it threatens to dismantle one of the ACA’s most significant achievements. “What JD Vance is talking about is a very substantive change that would be a complete replacement of the ACA,” remarked Cynthia Cox of KFF, a nonprofit health policy research organization.

Before the ACA’s implementation, health insurance did not universally cover pregnancy-related care, which can incur steep costs due to numerous medical appointments, tests, and the delivery process itself. Under Vance’s proposal, individuals who could become pregnant may be forced to purchase separate, more expensive plans targeting higher healthcare usage. Such plans could impose barriers like lengthy wait times or steep deductibles, complicating access to necessary services.

Even with comprehensive coverage, pregnancy-related healthcare imposes substantial expenses. A 2022 KFF analysis highlighted that people with employer-sponsored insurance faced nearly $3,000 in out-of-pocket costs during childbirth, with total expenses nearing $19,000. Depending on the execution of Vance’s plan, these costs might revert to patients. Since the ACA came into effect, studies have demonstrated that women are less likely to forgo healthcare due to costs and have seen a reduction in out-of-pocket expenditures.

The ACA also helped safeguard transgender individuals from being discriminated against based on their health status. Previously, insurers could classify being transgender as a preexisting condition, escalating costs for those individuals. Women, who historically utilized more healthcare services due to reasons such as contraception and regular screenings, might face similar issues again if Vance’s plan takes shape.

The political ramifications of Vance’s proposal are complicated. In 2017, Republican attempts to repeal the ACA were met with resistance, resulting in substantial losses for the GOP in the subsequent midterm elections. Currently, over 60 percent of Americans support the ACA, largely due to its protections for individuals with preexisting conditions. This raises questions about the viability of Vance’s proposed approach to healthcare reform.