The health care struggle is sharpening this fundamental tension in the GOP – CNN

Analysis of Proposed US Healthcare Policy Changes and Their Impact on Sustainable Development Goals

Introduction: Healthcare Policy in the Context of Global Development Objectives

Recent proposals to reform the United States’ Affordable Care Act (ACA) present significant implications for the nation’s progress toward key Sustainable Development Goals (SDGs). The debate centers on replacing the current subsidy structure with direct payments, a move that aligns with a market-based ideology but poses risks to the principles of universal access and equity that underpin the SDGs. This report analyzes these proposed changes through the lens of SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 1 (No Poverty).

The Affordable Care Act: A Framework for Advancing SDG 3

Current Achievements in Universal Health Coverage

The ACA has been instrumental in aligning the U.S. healthcare system more closely with the objectives of SDG 3, particularly Target 3.8, which calls for achieving universal health coverage, including financial risk protection and access to quality essential health-care services for all. Key achievements include:

• Reducing the national uninsured rate to a historic low of 8%.
• Expanding Medicaid coverage to approximately 20 million low-income adults.
• Establishing protections for individuals with pre-existing conditions, preventing discrimination based on health status.
• Providing subsidies that have made private insurance accessible for over 24 million people.

These measures represent a system of collective risk-sharing, where the healthy subsidize the sick, which is fundamental to ensuring that no one is left behind—a core tenet of the 2030 Agenda for Sustainable Development.

Proposed Policy Revisions and Their Mechanisms

Shifting from Subsidies to Direct Payments

The central theme of the new proposals involves a fundamental restructuring of financial support for health insurance. The primary mechanisms under consideration are:

1. The expiration of enhanced ACA subsidies, which would lead to significant premium increases for millions of beneficiaries.
2. The conversion of existing tax credits into direct payments deposited into individual health accounts (e.g., “Trump Health Freedom Accounts”).
3. The implementation of substantial funding cuts to the Medicaid program, projected to rescind coverage for approximately 10 million people.

These changes are intended to promote consumer choice and market competition. However, they dismantle the risk-pooling structure that is critical for maintaining affordable and comprehensive coverage for all populations, thereby threatening progress on multiple SDGs.

Assessment of Impact on Sustainable Development Goals

SDG 3: Good Health and Well-being

The proposed reforms pose a direct threat to the achievement of SDG 3. By design, they would segregate healthy and sick populations, leading to adverse outcomes:

• Erosion of Universal Access: Healthier individuals may be incentivized to purchase less comprehensive, high-deductible plans, leaving a sicker, more expensive risk pool for comprehensive insurance. This could trigger a “death spiral,” making robust coverage unaffordable for those with chronic conditions and pre-existing illnesses.
• Weakened Protections: The shift away from mandated “essential health benefits” and regulated premiums undermines the financial and health security for vulnerable populations.
• Increased Health Disparities: The loss of coverage and higher costs would disproportionately affect individuals with greater health needs, leading to poorer health outcomes and a reversal of progress toward universal health coverage.

SDG 10: Reduced Inequalities

The proposals are projected to exacerbate existing inequalities, directly contradicting the aims of SDG 10, which seeks to reduce inequality within and among countries.

• Socioeconomic Disparities: The greatest financial burdens would fall upon older, lower-income, and non-college-educated individuals. Data indicates these demographics have a higher prevalence of pre-existing conditions and are less able to absorb increased healthcare costs.
• Regressive Impact: While younger, healthier, and more affluent individuals may benefit from lower initial premiums, the system would effectively transfer wealth and health security away from the most vulnerable segments of society.
• Undermining Social Inclusion: By making essential healthcare unaffordable for specific groups, the policies risk marginalizing millions and deepening social and economic divides.

SDG 1: No Poverty

Access to affordable healthcare is a critical component of poverty reduction strategies, as outlined in SDG 1. The proposed changes could increase financial hardship and drive more families into poverty.

• Increased Financial Risk: The move toward high-deductible plans and direct payments would expose individuals to greater out-of-pocket costs, increasing the risk of catastrophic medical debt.
• Erosion of Social Safety Nets: Cuts to Medicaid and the reduction of subsidies weaken the social protection systems that prevent health crises from becoming financial catastrophes for low-income families.

Conclusion: A Conflict Between Policy and Sustainable Development

The ongoing debate over ACA reform highlights a fundamental conflict between two contrasting visions for society. The proposed policies prioritize market principles of individual autonomy and competition. In contrast, the Sustainable Development Goals are built on principles of solidarity, equity, and collective action to ensure universal access to essential services. The implementation of the proposed reforms would constitute a significant setback for the United States’ commitment to the 2030 Agenda, particularly in its efforts to ensure healthy lives, reduce inequality, and eradicate poverty for all its citizens.

1. SDGs Addressed in the Article

   The article discusses issues related to healthcare policy in the United States, specifically the Affordable Care Act (ACA) and proposed changes. This analysis connects to several Sustainable Development Goals (SDGs) that focus on health, equality, and poverty reduction.

   • SDG 3: Good Health and Well-being

     This is the most prominent SDG in the article. The entire discussion revolves around ensuring access to affordable health insurance and healthcare services. The debate over the ACA, subsidies, premiums, and coverage for people with preexisting conditions directly relates to the goal of ensuring healthy lives and promoting well-being for all at all ages.

   • SDG 10: Reduced Inequalities

     The article repeatedly highlights how different healthcare policies would disproportionately affect various demographic and socioeconomic groups. It explicitly states that proposed changes “would increase costs and diminish access for older, lower-income and non-college-educated people with greater health needs.” This focus on the unequal impact of policy on vulnerable populations directly addresses the goal of reducing inequality within a country.

   • SDG 1: No Poverty

     The article touches upon social safety nets that prevent individuals from falling into poverty due to healthcare costs. It discusses the ACA’s expansion of Medicaid for “working-poor adults” and subsidies that make insurance affordable. The potential loss of this coverage or an increase in out-of-pocket costs represents a significant financial risk that can push vulnerable families into poverty, linking the discussion to SDG 1.

2. Specific SDG Targets Identified

   Based on the content of the article, several specific SDG targets can be identified as being directly relevant to the policy debate discussed.

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

     The article is centered on this target. The debate over the ACA is fundamentally about the best way to achieve universal health coverage (UHC). The text discusses key components of UHC, including:

     • Financial risk protection: Mentioned through the discussion of “enhanced subsidies,” “large premium hikes,” and protecting people from prohibitive costs associated with “preexisting health conditions.”
     • Access to quality essential health-care services: The article discusses how policy changes could “diminish access” for certain groups and the importance of “essential health benefits” in all policies.

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

     This target is relevant because the article analyzes how proposed changes to the ACA could lead to the exclusion of specific groups. It notes that “older, working-class families” and those with “modest incomes and without four-year college degrees” would be on the “wrong side of these trade-offs,” potentially losing affordable access to healthcare and thus facing social and economic exclusion.

   • Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable.

     The ACA’s mechanisms, as described in the article, function as a social protection system. The “expansion of Medicaid eligibility to more working-poor adults” and the provision of “enhanced subsidies” are direct examples of social protection measures aimed at ensuring healthcare access for the poor and vulnerable, aligning with the objective of this target.

3. Indicators for Measuring Progress

   The article mentions or implies several quantitative and qualitative indicators that can be used to measure progress towards the identified targets.

   • Indicators for Target 3.8 (Universal Health Coverage)

     • Proportion of the population with health insurance: The article explicitly states that the ACA has “reduced the number of Americans without health insurance to only 8% as of 2023,” providing a direct quantitative indicator of coverage.
     • Number of people covered by specific health schemes: The article provides concrete numbers, such as “About 20 million people have obtained Medicaid coverage through that expansion” and “more than 24 million people” use the ACA exchanges. These figures serve as indicators of the reach of these programs.
     • Affordability of healthcare: While not providing a specific metric like out-of-pocket expenditure, the article’s focus on “large premium hikes” and the cost of insurance plans implies that premium costs as a percentage of income is a key indicator for measuring financial risk protection.

   • Indicators for Target 10.2 (Reduced Inequalities)

     • Disparities in health outcomes and access by socioeconomic status: The article implies the need for disaggregated data by citing a KFF analysis that found “people without a college degree are more likely than those with advanced education to suffer from a preexisting condition” and that “People with less income, likewise, are more likely to face preexisting conditions.” Measuring these disparities is an indicator of inequality in health outcomes.

   • Indicators for Target 1.3 (Social Protection Systems)

     • Coverage of social protection programs: The article indicates the scale of these programs by mentioning the number of beneficiaries. For instance, the risk of “large premium hikes for up to 20 million people” upon the expiration of subsidies serves as an indicator of how many people rely on this specific social protection measure. Similarly, the “20 million people” who gained Medicaid coverage is an indicator of the program’s reach among the “working-poor.”

4. Summary Table of SDGs, Targets, and Indicators

   SDGs	Targets	Indicators Identified in the Article
   SDG 3: Good Health and Well-being	Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services.	Percentage of the population without health insurance (stated as 8%). Number of people covered by Medicaid expansion (20 million). Number of people using ACA exchanges (24 million). Affordability of insurance premiums and risk of “large premium hikes.”
   SDG 10: Reduced Inequalities	Target 10.2: Promote the social and economic inclusion of all, irrespective of age, economic or other status.	Disparities in healthcare access and cost for older, lower-income, and non-college-educated populations. Higher prevalence of preexisting conditions among people with lower income and education levels.
   SDG 1: No Poverty	Target 1.3: Implement nationally appropriate social protection systems for the poor and the vulnerable.	Number of “working-poor adults” covered by Medicaid expansion (20 million). Number of people receiving enhanced subsidies to afford insurance (up to 20 million).

Source: cnn.com