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Political parties differ widely on health care

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According to their election platforms, the Democrats and Republicans agree that they would like to change the system established by the Affordable Care Act, but neither party looks to have enough clout to make their changes no matter who wins the presidency.

Those platforms “are more of a wish list than a to-do list,” said Geoff Manville, a principal at Mercer L.L.C. in Washington. They will, however, help “frame the debate on health care issues next year.”

The Democratic Party platform, approved at last week's convention in Philadelphia, heaped praise on President Barack Obama and congressional Democrats for taking “a critically important step toward the universal health care” by approving the ACA, “which has covered 20 million more Americans and ensured millions more never will be denied coverage because of a pre-existing condition.”

Not surprisingly, the GOP platform has a different view.

ACA “has imposed a euro-style bureaucracy to manage its unworkable budget-busting conflicting provisions,” according to the GOP platform. “A Republican president, on the first day in office, will use legitimate waiver authority to halt its advance and then, with the unanimous support of congressional Republicans, will sign its repeal.”

Those differences are “significant,” said Allison Klausner, a principal and government relations leader at Xerox HR Solutions in Washington. “The GOP platform backs complete repeal of ACA, while the Democrats say they will improve and build upon it.”

For example, the Democratic platform says the federal government should provide coverage in the public exchanges, a proposal that likely responds to decisions by UnitedHealth Group Inc. and Humana Inc. to stop offering exchange coverage in certain states next year.

It also responds to the long-time support by former presidential contender Sen. Bernie Sanders, I-Vt., for a single-payer national health insurance system, Mr. Manville said.

The GOP platform would ask state officials to reconsider “medical mandates” that require insurers to offer certain benefits in their health plans.

Such mandates “price millions of low-income families out of the insurance market.” In addition, the GOP platform says more price transparency concerning medical services is needed.

The GOP platform also supports growth of health savings accounts, saying HSAs “empower patients.”

The HSA proposal “is not surprising. Republicans are very supportive of that,” said Katy Spangler, senior vice president of health policy at the American Benefits Council in Washington. Several weeks ago, GOP members of the House Ways and Means Committee united to pass legislation that would significantly increase the maximum annual HSA contribution limit starting in 2017.

In addition, the GOP platform advocates continuing the current ban on employers and insurers denying coverage to people with pre-existing medical conditions who have not allowed their prior coverage to lapse.

Without going into detail, the platform says individuals buying health insurance should receive tax breaks, and individuals should be able to buy policies from out-of-state insurers.

While the Democratic Party platform backs the ACA, it does suggest some changes.

For example, the platform would reduce the ACA's annual out-of-pocket limit, which currently is $6,850 for single coverage and $13,700 for family coverage. It also would repeal the 40% “Cadillac” tax on premiums that exceed $10,200 for single coverage and $27,500 for family coverage employers are to face in 2020.

“There is a lot of detail here,” said James Gelfand, senior vice president of health policy at the ERISA Industry Committee in Washington. But the Democrats' plan, which also advocates expanding Medicare eligibility and adding a public health plan to the exchanges, does not suggest how to replace excise tax revenue.

“Where will the money come from? Will there be new taxes on employers or providers? We don't know that,” Mr. Gelfand said.

Earlier, the Congressional Budget Office projected that the excise tax would raise $87 billion in new revenue from 2018 through 2025, based on the assumption that employers cutting benefits to stay under the tax trigger would boost employees' taxable wages. Experts, however, question the validity of that assumption.

Not surprisingly, the party platforms partially mirror the presidential candidates' stances.

For example, Democratic nominee Hillary Clinton backs a lower Medicare eligibility age, repealing the ACA excise tax on costly plans and reducing out-of-pocket health plan limits.

GOP nominee Donald Trump has called for repealing ACA and giving people buying health insurance a tax break.

While Democrats held a Senate supermajority that prevented Republicans from blocking ACA in 2010, this election is different.

“Regardless of who is elected president,” neither party is likely to have supermajority in the Senate, making legislative changes more difficult to pass without broad bipartisan support, ABC's Ms. Spangler said.