Biden has a real plan to lower health care insurance costs

Jennifer and Mike Rupprecht raise grass-fed beef and free-range chicken near Lewiston in southeastern Minnesota. And while their family farm isn't likely to be a stop during the 2020 presidential campaign, it should be.

Few people better illustrate the substantial work yet to do nationally on a vital issue — health care. The couple, both 62, have long bought health insurance on their own because they are self-employed. Affordability was a challenge before the Affordable Care Act (ACA) was passed, and it continues to be after long after the law's implementation.

The problem: Like many farm families, the couple earns too much to qualify for the ACA's financial assistance to discount monthly insurance premiums, but not enough to comfortably shoulder coverage costs. They pay $1,900 a month for a plan through a Minnesota insurer, and their combined annual deductible is around $13,000.

The Rupprechts have watched the debate over whether to repeal the ACA or keep it, and they feel like they've "fallen through the cracks" of this either-or approach. This campaign year, they're watching for solutions big and small that can help them and others in the same situation. "We hope our voice can be heard," Jennifer Rupprecht said.

While COVID-19 continues to dominate headlines, the debate needs to go beyond containing the pandemic. It's time to put a spotlight on presidential candidates' health care platforms so that families in Minnesota and elsewhere can make informed decisions before November.

Unfortunately, even though his first term is near its end, President Donald Trump has yet to detail the plan he promised in a July 19 interview to deliver in two weeks. His administration also has aided and abetted yet another serious legal challenge that seeks to overturn the ACA. If it succeeds, ACA subsidies for those who buy insurance on their own would evaporate.

Other collateral damage if the lawsuit succeeds: eliminating guaranteed coverage for pre-existing conditions and the loss of "doughnut hole" protection for seniors on Medicare who struggle with prescription drug costs. Trump has promised to require insurers to cover pre-existing conditions, but unless he also sets a reasonable ceiling on what insurers can charge, it could result in those with poor health simply being priced out of the market.

The Rupprechts would benefit from a number of the reforms Biden backs. One ACA fix he's proposed involves lifting the income cap that keeps this Minnesota farm family and others from being eligible for subsidies. Another fix: changing the aid calculation to help people buy a plan with lower out-of-pocket costs. If Congress would pass these reforms, the Rupprechts would likely see their premiums instantly discounted and their deductible lowered.

Jennifer Rupprecht also sees promise in another Biden proposal: allowing Americans of all ages to buy into a government-run plan like Medicare. Currently, the qualifying age is generally 65 and older. With the government's purchasing power, savings could be passed onto those enrolled in what's often dubbed the "public option" approach. Passing it, however, could be an uphill battle politically because commercial insurers often reimburse medical providers at higher rates, and the two would team up in opposition.

Biden has also previously called for lowering the Medicare eligibility age to 60. That, too, would be a challenge politically, but it could also help the Rupprechts, who are three years away from qualifying.

Both Trump and Biden have commendably vowed to tackle prescription drug costs. The campaign would benefit from additional details from Trump in particular about his plan to do this, and in turn, greater debate over this pocketbook issue. In a normal year, health care would be front and center as the candidates vied for support. Containing COVID-19 shouldn't overshadow the needed debate on what else can and should be done to ensure that Americans have robust coverage they can afford.