Americans are casting their votes in what may be one of the most pivotal elections in American history. The outcome will determine the future of healthcare in this country for decades.

The Trump administration and Senate allies have made clear their intent to dismantle the Affordable Care Act (ACA, or Obamacare) through a combination of executive orders, legislation, and legal challenges. Also, the Trump administration announced it would permanently end the payroll tax if he is re-elected; but this is the tax that funds Social Security and Medicare. Ending it would essentially bring these critical entitlement programs for seniors to an end.

Alternatively, the Biden-Harris ticket and the Democratic Party have made improving on the ACA and adding elements of the Medicare-for-all movement to increase coverage for Americans a central plank of their platform. They have also vowed they would protect Social Security and Medicare from cuts.

The difference between the two parties and their approach to healthcare is what is on the ballot for healthcare in 2020. Will healthcare become a “right” or a “privilege” for Americans?

Five predictions:

• Universal healthcare/Medicare-for-all will either establish its foundation in a hybrid ACA/Medicare/Medicaid model with a Biden victory, or it will continue to be under constant assault from all sides with a Trump victory. The outcome of the election will decide if we enter into a divisive period of history between the haves and have-nots resembling “The Healthcare Hunger Games.”
• America’s population of 65-plus will grow to the point that it surpasses the population of 18 and under in less than 15 years. A mass exodus of retiring workers will shrink the tax base to support them in retirement, exerting even more stress on already beleaguered entitlement programs. Increasing demand on Medicare and Medicaid will fuel growth in private-pay resources such as reverse mortgages and life settlements to cover the costs of senior care supports and services.
• Despite attempts to scapegoat entitlements for ballooning budget deficits and the national debt, the reality of these programs’ importance to millions of Americans will trump political demagoguery. Meaningful reforms to shore up the fiscal solvency of Social Security, Medicare and Medicaid will continue.
• Employer-based health coverage only works when people are employed; 158 million people (more than half of all Americans under the age of 65) had employment-based (group) health insurance at the beginning of 2020. But today, 40 million people have found themselves unemployed due to the coronavirus outbreak. Employer-based health insurance has been the primary means to cover Americans, but redefining what employment looks like going forward will have to take into account an overreliance on a stable and growing economy as the primary way for people to obtain affordable health insurance coverage.
• Medical staff and supplies stretch thin quickly during a crisis, and the impact of the coronavirus on healthcare will be long-lasting. The inequities of healthcare across economic and racial lines will need to be addressed, and the debate over how healthcare is paid for will only get more intense. The need for more medical professionals and also overall support staffing will become a problem as many will question if this is a field they want to be in. The shortages of supplies forcing hospitals to crowdsource for things such as homemade masks have shown how important preparedness is and the need to stockpile materials.

A nation’s healthcare system reflects its values, and the outcome of this election will be a lasting statement that will impact every single American.

Chris Orestis (www.retirementgenius.com), who wrote this article, is president of LifeCare Xchange and has 25 years experience in the insurance and long-term care industries.