OTTAWA -- The months-long pandemic has catapulted the hotly debated issue of American health-care reform to the forefront of political discussion and as the election nears, experts say its likely to intensify.

The U.S. remains home to the highest confirmed cases as well as the highest number of deaths related to COVID-19, calling into question both President Donald Trump’s response and the conditions of the country’s historically fragmented health-care system absorbing the weight of the outbreak.

Job loss from the pandemic has meant a large swath of Americans have been left without employer-sponsored insurance. The non-profit Kaiser Family Foundation estimates that up to 27 million people could lose their health plan, and while about half may be eligible for Medicaid, nearly 6 million won’t have access to subsidized coverage.

While Trump has stayed mostly mum about the devastating health impact of the pandemic, his administration continues to promise a new health-care plan that would replace the current model, just weeks out from the fall election. It’s a plan that will either guide the country through the next four years in which reining in the virus will be a key priority, or it will die on the evening of November 3, being replaced instead by that of his Democratic rival.


Over the course of the last three-and-a-half years, Trump’s health-care plan has been as much about reversing former president Barack Obama’s policies as it has been about advancing a new vision.

Trump’s commitment to overturn the Affordable Care Act (ACA), known as Obamacare, has remained steadfast since he announced his presidential run in 2015.

He gave himself an aggressive timeline to start making changes, pledging that "On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare," read his campaign website. In reality, it took many months before Republicans put forward a series of proposed amendments which were ultimately shot down.

Critics of the ACA says it’s too costly of a system and still leaves a significant number of Americans uninsured. Republicans have notably taken issue with changes to the marketplace system which has those who can afford to buy directly from an insurance provider help fund subsidies for those that can’t.

But Chief Washington Correspondent for Kaiser Health News, Julie Rovner, told in a phone interview that Republicans never put forward an alternative option.

"There has never been a Republican replacement plan for the Affordable Care Act and even what they were voting on in 2017 wasn’t really a soul replacement,” Rovner said. “There was basically shells and an outline and Trump keeps promising he’s going to have a plan and then it never shows up in three-and-a-half years."

Trump committed in late July in an interview on Fox News that his team’s health-care platform would be revealed in two weeks. He later pushed the deadline back to the end of August, and as of publication, no plan has been released.

His administration has been forced to focus their talking points over the last eight months on health-care-related activity though, as a result of the pandemic. Trump has touted the country’s testing capabilities, saying it’s the cause of higher case count reporting. He has also praised his team’s efforts for shutting off travel with China, securing medical supplies and sourcing vaccine candidates.

"While Democrats were focused on their impeachment sham, President Trump took swift and decisive action to stop travel from China in January and enhanced airport screenings to help stop cases from coming into the United States as long as possible," reads the White House website.

Rovner says she’s curious to see how the Trump camp uses their COVID-19 response to bolster their election campaign and whether it will inspire Republicans to rethink their original plan to reconfigure health care at a time when about 1,000 Americans are dying a day from the worst pandemic in a century.

"The Republicans have basically spent the last decade trying to tell Americans not to trust government and not to trust science and now we’re in the middle of a pandemic where it’s really important to trust both," she said.


As Obama’s former right-hand man, Biden has pitched to not only uphold the 2010 law but expand it.

According to his campaign website, "Instead of starting from scratch and getting rid of private insurance, [Biden] has a plan to build on the Affordable Care Act by giving Americans more choice, reducing health care costs, and making our health care system less complex to navigate."

The "Biden Plan" among other priorities, proposes to give more Americans the option to buy into a public health insurance plan like Medicare, would increase tax credits for health insurance, and repeal the existing law that bars Medicare to negotiate lower drug prices.

"The two general camps among Democrats are, let’s fix Obamacare and let’s scrap everything and do Medicare for All, and there are variations within but generally they lean towards one or the other and he definitely leans towards the let’s fix Obamacare," said Rovner.

Biden also touts a separate COVID-19 related plan on his campaign website that in the short-term would make virus testing free and widely available, allocate more funding to the development of a vaccine, and instill emergency paid leave for those who have been impacted by the virus. It goes on to offer long-term solutions including establishing a first responder system, scaling up biomedical research, and implementing disease surveillance.

In an interview with ABC News on August 23, following the Democratic National Convention, Biden said he wouldn’t hesitate to shut down the economy as president if scientists recommended it and transmission of the virus hadn’t slowed.

"I would be prepared to do whatever it takes to save lives. We cannot get the country moving until we control the virus," he said.


Sara Collins, Vice President of Health Care Coverage and Access at The Commonwealth Fund, told that health care will take centre stage this election, even more so than it usually does.

"Health care will definitely be a top issue this year because of COVID-19. It likely would have been a top issue even in the absence of COVID-19 but that has certainly underscored the problems in the health system," she said.

If Trump pulls off a win, Collins says while it’s probable Republicans will continue to try to repeal the ACA, their chances of getting changes approved in Congress are less likely during a second term.

"As more and more people have gained coverage through the law over the last ten years since its passage, and particularly since the major expansions have come into place, there’s just a lot more support for it and the idea of repeal is not very popular," said Collins.

However, the Supreme Court will hear arguments a week after Election Day on November 10 regarding a Republican-backed lawsuit that deems the ACA’s individual mandate provision unconstitutional, after being zeroed out by Trump’s 2017 Tax Cuts and Jobs Act. A decision is expected in June, 2021.

If, on the other hand, Biden becomes president, Collins says expect steps to be made to amplify what exists. She said there will likely an expansion in premium-free coverage for Americans in states that have yet to introduce Medicaid and increased subsidies for those who can’t afford insurance in the individual market.

"These are not massively expensive things for the U.S. to do, they’re reasonable in terms of budget costs," she said. "There’s been several proposals like this already introduced in Congress over the last several years obviously by Democrats and so there’s political appetite."

How the pandemic will impact reform debate and visa versa is unclear, added Rover, but what’s for certain is that COVID-19 has exposed the underbelly of the U.S. health-care system that can’t be ignored.

"There are huge inequities that have been built into the U.S. healthcare system for decades now and suddenly they’re just out there bare for everyone to see,” said Rover. “I’m waiting to see if at some point COVID-19 really changes the national conversation about healthcare, if this is what it takes."