How does the Presidential Election Affect Special Needs Law?

Posted on: November 4th, 2016 by Mark R. Friedman

The President of the United States is the leader, executive and commander in chief of the most powerful nation in human history.  Who serves as president, and the policies and vision he or she brings to the job, directly affects your life in myriad ways.  You can find some of those ways in the many, many articles and reports that have been written about this presidential election thus far.  But I want to focus on one aspect of the election near and dear to FriedmanLaw:  how the next president will affect our special needs clients.

Hillary Clinton has made representing people with disabilities a visible part of her campaign, while Donald Trump has had well-publicized spats with the community.  But beyond their personalities, each candidate brings different policy visions to the table.  The most obvious and important one is their differing views on the Affordable Care Act (aka, ObamaCare).

I have written extensively about how the Affordable Care Act affects people with disabilities. There are winners and losers to the Affordable Care Act (“ACA”), and some of the biggest winners are people with disabilities who need a lot of medical care.  People with long-term disabilities benefit immensely from the pre-existing condition requirement – that insurers can’t refuse to insure someone because they have a pre-existing condition.  Likewise, they also benefit from the ACA’s prohibition on insurers setting a maximum limit on lifetime care.  That’s because some people born with disabilities need an enormous amount of medical care over their lifetimes, such that from a commercial perspective, insurers would never be willing to insure them.  The ACA requires that insurers cover these folks.  This means that private insurance is an option for many people with disabilities where it wasn’t before, which opens up a variety of benefits and planning opportunities.  Instead of relying on Medicaid and its limited network, a person with disabilities might be able to see a world-renowned doctor covered by insurance.

The ACA is essentially the healthy subsidizing the sick and the young subsidizing the old.  The reason premiums have increased so much is that millions of people with pre-existing conditions have signed up for insurance, and America is aging and more of the population has age-related health problems.  Insurers have to spend more to cover their customers’ costs, and they pass that on to all of us in the form of higher premiums.

Now, where do the candidates stand on the ACA?  Hillary Clinton has said she wants to build on the ACA and expand it.  Her vision likely includes a public option for health insurance, similar to Medicare.  Donald Trump has said he wants to repeal and replace the ACA.  He hasn’t been specific of what he wants to replace it with, but he has said that he wants to keep the ban on insurers refusing to insure pre-existing conditions.  More broadly, he said during one of the Republican primary debates that we can’t have a system that allows people to die in the streets.

The problem with Trump’s plan is that, in order for insurers to insure people with pre-existing conditions without going bankrupt, they need a lot of healthy and young people to sign up.  So far, not enough healthy young people have signed up, which is why the ACA has had problems.  So if Trump wants to keep the ACA provision about pre-existing conditions (which is broadly popular), whatever he replaces the ACA with will have to include a similar mandate that everyone must sign up for insurance.  (Otherwise, the health insurance companies will never support his plan.)  And ultimately, we’ll end up with something similar to the ACA.

So, each candidate has a different vision regarding the Affordable Care Act, which will affect people with disabilities.  Whoever you support, make sure you vote on Tuesday, November 8!  You can find your New Jersey polling place here:

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