Breaking Down the Issues That Matter Most to Families in the 2020 Election

President Trump has made big moves in the health insurance industry including arguably the biggest one: seeking to overturn the Affordable Care Act (ACA). The administration has eliminated the ACA's individual mandate, which requires all Americans to have insurance or pay a penalty and is key to keeping younger and healthier people enrolled in the market. The result of this has been increased premiums from three percent to 13 percent for bronze plans (which are plans with the least expensive premiums and higher copays and coinsurance) and a drop in enrollment by almost three million people.

President Trump says his new solution will be lower cost health care with higher-quality service for Americans, though no official replacement plan has been rolled out at this time. And though little has been said regarding President Trump's approach to health insurance for children, under the SUPPORT Act and the Improving Recovery and Reunifying Families Act signed in 2018, $15 million has been authorized for a recovery coach for parents dealing with substance abuse who have children in the foster care system to help them spend as little time in foster care as possible. He also signed an Executive Order in 2019 for the Transparency in Coverage rule, which would force hospitals to display prices online, so that consumers won't be blindsided by costs from common operations to childbirth.

Presumptive Democratic nominee Joe Biden plans to build on the ACA, which he helped pass during his time as President Barack Obama's vice president. Biden plans to provide a Medicare-like public option for insurance, specifically for small businesses or individuals and families who don't have access to or can't afford private or employer-provided insurance. This option would also be available for low-income families who live in one of the states that have not yet expanded Medicaid coverage per the ACA's guidelines. Biden has also pledged to help middle-class families by lowering the limit on the cost of coverage from 9.86 percent of income to 8.5 percent. This means the most a family would spend on insurance in the marketplace wouldn't be more than 8.5 percent of their income. Tax credits would also be adjusted so that families can get better coverage, paying lower deductibles and out-of-pocket costs.

While there's no mention specifically of his plans for child health care yet or his ideas for helping lower the cost of childbirth in the U.S., he's stated that by building upon and protecting the ACA, the financial and emotional stress of caring for a sick child will be lessened. For example, the law eliminates the ability of health care insurers to impose lifetime caps on coverage or deny coverage for a preexisting condition. Biden will also adopt California's public-private partnership plan and its Maternal Data Centre to improve the U.S. childbirth mortality rate, which is three times higher among Black women than non-Hispanic white women.

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Both candidates want to increase jobs through infrastructure opportunities — the buildings, roads, power, and supplies states need in order to function. While a lot of the job growth that had occurred during the Trump presidency has been diminished by the coronavirus pandemic, he's called for a $2 trillion infrastructure bill to help bring jobs and the economy back to life, in addition to suspending immigration in order to protect jobs for American citizens.

Biden has said he wants to focus job growth on clean energy jobs specifically to help the country move to less greenhouse gas emissions and increase funding for the Manufacturing Extension Partnership in order to boost jobs for the middle class.

But the biggest difference when it comes to working families and jobs is how each candidate wants to approach minimum wage. Currently 1.8 million Americans make at or below the federal minimum wage, which is approximately 2.3 percent of the workforce. President Trump has said he'd like to see federal minimum wage increase (currently it's $7.25 per hour), but believes the states should have the right to raise minimum wage higher than the federal minimum. Biden has called for a nationwide $15 minimum wage as part of his campaign.

President Trump has provided student loan relief during the coronavirus crisis but has continuously vetoed legislation that would block efforts to limit debt relief for defrauded student loan borrowers. With his Tax Cuts and Jobs Act of 2017, those who received loan forgiveness through the Total and Permanent Disability Discharge (TPD) program cannot be taxed on the amount they receive, but it also nixed previous tax deductions you could make for certain school expenses like enrollment fees, tuition, textbooks, and more. His 2020 plans include one income-driven repayment plan, which would increase monthly payments from 10 percent to 12.5 percent of a borrower's income, while forgiving what's left of student loans after 15 years instead of 20.

Biden so far has proposed immediately canceling $10,000 of student debt per person in response to the coronavirus crisis, as well as forgiving federal student debt for low-income and middle class individuals who have attended public colleges and universities, in addition to Historically Black Colleges and Universities (HBCUs) and private, underfunded Minority-Serving Institution (MSIs). This would include those who attended public colleges and universities making up to $125,000 with phase-outs depending on salary. Those making $25,000 or less wouldn't be forced to make any monthly payments (or accrue interest on their loan in the meantime), while those earning more than $25,000 wouldn't be forced to pay more than 5 percent their income toward their loans. After 20 years, all remaining loans would be forgiven without tax penalties.

This is perhaps one of the biggest issues for working families. According to Child Care Aware of America, married couples pay 11 percent of their income toward child care, and for single parents, it's roughly 36 percent. With the help of senior adviser and daughter Ivanka Trump, child care has been a focus through President Trump's policy making. In his proposed 2021 fiscal budget is a one-time $1 billion investment to build out more child care options, including programs through employers. He made a similar effort in his 2020 budget, allocating $1 billion to increase affordable child care options in underserved communities, in addition to signing a $2.4 billion funding increase for the Child Care and Development Fund, which provides financial assistance to low-income families so they can work. President Trump also recently approved paid parental leave for federal workers for 12 weeks.

Biden hasn't rolled out a child care specific plan yet, though he has touched on early childhood development, proposing universal pre-K for 3-year-olds and 4-year-olds, which could help offset child care costs. Where he has gotten more specific is in maternal and family health, stating he'd like to give states funding to place early childhood development experts in community health centres, as well as for home visits through the ACA for new parents who need help with both child or maternal health issues. He's been a supporter of the Family and Medical Leave Act, and has recently said he believes Americans should get 12 weeks of paid leave to care for a child or sick family member.

The Trump administration made headlines recently when they pushed to rollback health care protections for transgender individuals, even as the Supreme Court ruled that sex includes sexual orientation and gender identity, and discrimination based on this is illegal when it comes to employment specifically. If these rules aren't withdrawn it could set off a chain of lawsuits. In addition to this, the Trump administration is working on rules that could make it easier for adoption and foster agencies to refuse to work with same-sex couples. The Biden campaign is taking the opposite approach with no policies stated yet, but fully supporting LBGTQ+ rights. This includes access to health care (along with nondiscrimination for coverage or treatment through the ACA) and providing the ability to build and start a family.