RENEE MONTAGNE, HOST:
Health care - and Obamacare in particular - has dominated the debate between Republicans and Democrats for years, until this year. Candidates had plenty to say in campaign 2016 but rarely touched on the issue of America's health care system. Over the past few weeks, MORNING EDITION has hosted a series of conversations called What's The Issue, asking you to tweet us your top election issues with the hashtag #DearWashington. Many of you brought up health care. Here's a sampling.
JODY THERON: Dear Washington, everyone in family has asthma. We need daily prescriptions and rescue prescriptions at all times plus regular checkups.
COLBY KLAUSE: Dear Washington, I suffer from treatable mental health problems, but I can't afford the treatment. I just want medication to get me back to having a career.
JIM FOTH: I can barely afford my health care premiums each month. It's roughly another car payment for me. It's depressing when I think about how good the rest of the world has it.
MONTAGNE: How good - how good had the rest of the world has it. That was Jody Theron (ph), Colby Klause (ph) of Nebraska and Jim Foth (ph), just some of the people who reached out to us on how important the issue of health care was to them. With us now to talk about the two major candidates and what they're proposing is NPR health policy correspondent Alison Kodjak. Good morning.
ALISON KODJAK, BYLINE: Good morning, Renee.
MONTAGNE: Now, health care has not come up, a bit surprisingly, that much in this campaign, but it did come up this week after the Obama administration announced the new rates for insurance plans for 2017. Recap the news for the coming year.
KODJAK: The overall rates for insurance bought through the Obamacare exchanges are going to go up an average of 22 percent across the country. Some states, the increases will be bigger, some will be smaller. But for consumers who qualify for subsidies, which are most of them, they won't really see an increase because those subsidies increase along with the rates.
MONTAGNE: OK, so not exactly 22 percent there, maybe, for most people. But Donald Trump did come out at a rally in Florida yesterday with a reaction to this news. Let's take a listen.
(SOUNDBITE OF ARCHIVED RECORDING)
DONALD TRUMP: Obamacare is just blowing up. And even the White House, our president, announced 25 or 26 percent. That number is so wrong. That is such a phony number. You're talking about 60, 70, 80 percent in increases, not 25 percent.
MONTAGNE: Well, 60, 70, 80 - who's right here?
KODJAK: Well, the 25 percent number that he's saying is basically the average increase for insurance policies sold on the federal exchange. There are also state exchanges. Their rates are going up a little less. So on average across the country, it's only 22 percent. However, on individual states, the increase could be much higher.
In Alabama, for example, it's showing an increase of 58 percent on average. And in Arizona, they're more than doubling. But again, it's state by state. In Indiana, rates are actually looking to go down. But still, for consumers, the subsidies are going to cover most of the increases that are showing on these numbers.
MONTAGNE: So let's stay with Donald Trump. What is he proposing to do?
KODJAK: Well, let's listen to a bit more about what he said at that rally.
(SOUNDBITE OF ARCHIVED RECORDING)
TRUMP: Obamacare has to be repealed and replaced, and it has to be replaced with something much less expensive for the people. And, otherwise, this country's in even bigger trouble than anybody thought.
KODJAK: So Donald Trump has repeatedly called Obamacare a disaster. And he says, like many Republicans do, that he wants to repeal it and replace it. However, he hasn't offered a lot of details about what he's going to replace it with. So he has a couple of specific proposals. One is to expand what are called health savings accounts.
And those allow people to save money, tax-free, and use that money to offset their health care costs. And a second proposal he has offered is to allow insurance companies to sell insurance across state lines. Right now, they have to get licensed in every state and sell within different states.
He says that by allowing them to sell insurance across state lines, it'll increase competition among insurers and therefore reduce the premiums that are sold. But he doesn't have a lot of details about what'll happen to that 20 million people who've gotten insurance so far under the Affordable Care Act.
MONTAGNE: And Hillary Clinton, what is she saying?
KODJAK: So Hillary Clinton has a much more detailed plan. Let's start by listening to what she said at the second debate.
(SOUNDBITE OF PRESIDENTIAL DEBATE)
HILLARY CLINTON: Now, with respect to the Affordable Care Act, I've been saying we've got to fix what's broken and keep what works. And that's exactly what we're going to do. I am committed to making sure that people retain coverage that they can afford. And that is going to require taking on premium cost and deductible cost and prescription drug cost.
KODJAK: So what Clinton has said over and over again is that she wants to build on Obamacare - keep what works, get rid of what doesn't. And her central theme has been to figure out how to deal with the cost. Increasing health care costs are the major problem, so she's proposed putting a cap on what people's out of - out-of-pocket health costs can be, taking a look at a big insurance company mergers because she says that is reducing competition and also looking at increasing drug prices. It's been big in the news lately, and she wants to look at why drug companies are raising prices and whether those price increases are justified.
MONTAGNE: So in a nutshell, Alison, what are the options that voters have here?
KODJAK: Well, if Donald Trump has his way, he will repeal and replace Obamacare, and that will actually end up with 20 million people who have gotten insurance so far having to look for something new. And we don't really know what that something is going to be. If Hillary Clinton gets her way, there'll be a much bigger role of government in health care.
She's proposed a couple of other things, including allowing people who are 55 years and older to buy into Medicare earlier than they are currently eligible. And she's brought up the public option again. That's the option of having the government offer health insurance in competition with private companies on the exchanges.
MONTAGNE: NPR health policy correspondent Allison Kodjak, thanks very much.
KODJAK: My pleasure, Renee.
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