A letter from the editor:
Most simply, wellness is the active pursuit of good health. It’s nourishing your body with food and clean water, getting good sleep, and receiving the medical care you need to keep you well and help you when you’re sick. The leggings and juices are nice (great, even!), but they’re surplus to requirement.
Those foundational necessities for physical and mental well-being, however, are not guaranteed. In order to put food on the table, it must first be harvested from the ground—and after that, you must have money for groceries. To sleep well, you must have a place to lay your head (and enough relief from stress to clear your mind). To receive life-saving medicine, it must be available and affordable. Each of these things—and so many more—are determined by the decisions made in Washington.
Wellness and politics cannot be separated. The outcome of the 2020 election will absolutely have an impact on your well-being, and over the next six weeks, we’ll take a look at the ways it will affect four key areas: health-care access, reproductive rights, financial wellness, and climate change.
Why these four? Let’s take them one by one.
- Access to affordable and reliable health care is a bare-minimum condition for well-being—never has that been more clear than now, when the COVID-19 pandemic has already claimed over 200,000 American lives.
- For our majority femme and female-identifying audience (and for many others, including trans men and nonbinary folks), health care involves contraception and the ability to safely get an abortion should you so choose. And, as outlined in greater detail below, cases like Roe v. Wade that are heralded as wins for reproductive freedom can have implications that ripple beyond just access to abortion and birth control: Should the ruling be overturned, LGBTQ+ rights are also at risk.
- Financial wellness is a major determinant of health: According to the Office of Disease Prevention and Health Promotion, well-being is shaped “by access to social and economic opportunities…The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.” Where you live, your education, your debt, your ability to earn income and save money—all have been linked to quality of life and longevity, including one’s risk for disease.
- That brings us to climate change. Climate change is making fresh air, clean water, and farmable land scarce. It’s displacing millions of people from their homes. Truly, we cannot be well if the planet is not, and if swift action is not taken to mitigate the effects of climate change, there will be no future for anyone.
Below, lawyer and journalist Jill Filipovic dives deeper into each area, illuminating how things will change depending on whether Donald Trump or Joe Biden wins the presidency in November.
Executive Editor, Well+Good
Access to Health Care
The next four years—heck, the next four weeks—will indelibly shape the future of American health care: Who has access to it, what’s covered, and what our insurance and health-care systems look like. Access to health care is And that, in turn, will impact each of our physical and mental well-being.
The Affordable Care Act (ACA), which was signed into law in 2010, radically expanded health-care access in the United States, providing health insurance to more than 20 million people. The Act did that in two ways: It created insurance marketplaces (federal and state-run) where people could compare insurance plans and sign up, and it offered states incentives to expand their Medicaid programs, so that people living on the financial edge could have insurance and get care when they needed it. In the years following the passing of the ACA, rates of uninsured people plummeted.
Millions of Americans now rely on the ACA for their health insurance, and even those who have private or work-sponsored insurance enjoy certain protections and benefits because of the ACA. The ACA, for example, mandates that insurers can’t deny coverage because of a preexisting condition, something that had previously left thousands of people unable to find adequate health insurance—before the ACA, people were denied for having asthma or high blood pressure, or for having had a baby, or for being a victim of domestic violence. The ACA mandated that primary care, including contraception, be fully covered. It allowed young adults to stay on a parent’s health care plan until age 26. It ended gender discrimination in insurance rates: Before the ACA, women were charged as much as 45 percent more for health insurance than men were. And it even required that employers give postpartum women reasonable time and privacy to pump breast milk.
President Trump opposes the ACA, saying that he has his own, better health plan. But during his tenure, he hasn’t introduced it or published it anywhere, making it impossible to assess his proposal against Biden’s. He has, however, undermined several critical components of the ACA, including repealing the individual mandate penalty, a fine on taxpayers who remained uninsured, which was a way of incentivizing everyone to get health insurance and keep costs down across the board. He did little to fund advertising for the ACA marketplace enrollment period, and got rid of many of the tools that helped people to enroll; under Trump, ACA enrollment predictably dropped. And his administration made it easier for employers to deny employees contraceptive coverage in their health insurance plans.
If the ACA is invalidated, the impacts will be vast. Twenty-one million people could find themselves uninsured. The 133 million Americans with preexisting conditions could be denied coverage.
Trump also supports legal efforts to gut or entirely destroy the ACA. One case that could get rid of the ACA entirely is headed to the Supreme Court before the election, leaving the health-care law particularly imperiled in the wake of Ruth Bader Ginsburg’s death. The Supreme Court could strike the law down, ending the ACA as we know it. Or, if there are only eight judges on the bench instead of the usual nine, the Court could be evenly split down the middle. In that case, the final decision would revert to that of the lower court. And in this case, the lower court invalidated the entirety of the law.
If the ACA is invalidated, the impacts will be vast. Twenty-one million people could find themselves uninsured. The 133 million Americans with preexisting conditions could be denied coverage. Hundreds of millions will find themselves paying more for both insurance premiums and care itself. Millions of young people will no longer be eligible to stay on a parent’s plan. Because there is no Trump plan on the table, we don’t know what the president will do to address these problems.
That said, critics and supporters agree that the ACA is far from perfect. Health-care costs remain sky-high in the United States, and outcomes are relatively poor compared to what we spend. Insurance premiums are absurd: The average employee-sponsored health insurance plan has a family paying some $20,000 annually in premiums alone.
Trump has not spelled out what he would do about those issues, either. Joe Biden has proposed expanding the ACA, most notably with a public option—something akin to Medicaid, which would cover low-income people the nation over, regardless of whether they live in a state that expanded Medicaid. His proposal would also increase subsidies on the ACA exchanges. And he would lower the Medicare eligibility age to 60. For those who want expanded health-care coverage in the United States, the Biden plan promises to at least deliver the basics, although it is very far from the Medicare for All plan that Senator Bernie Sanders proposed in the Democratic primary. And it is at the very least more specific than the nonexistent plan that the Trump White House has promised and not delivered for four years.
When it comes to reproductive rights, the differences between Biden and Trump are clear and fundamental. Biden has pledged to maintain and ideally expand access to abortion and contraception. Trump, on the other hand… “We have to take Donald Trump at his word on abortion,” says Jennifer Gunter, MD, a San Francisco-based OB/GYN and author of The Vagina Bible. “A goal of his administration is to make abortion illegal.”
He has also made contraception more difficult to get. Last year, Trump announced a rule that would pull federal family planning funding from any organization that provided services related to abortions—even if the service was simply a referral, and even if the services were paid for with the organization’s own, non-governmental dollars. It was a rule intended to target Planned Parenthood, and it worked: The organization pulled out of the federal Title X program, which helps to fund family planning for low-income women.
Another Trump administration rule has expanded American anti-abortion politics outside of America’s borders, pulling U.S. global health funds from organizations overseas that provide abortions, refer women to safe and legal abortions, or advocate for abortion rights. Research indicates that this particular rule, which opponents call the “global gag rule,” actually increases abortions and maternal deaths.
As Trump tries to fill the Supreme Court seat vacated by Ruth Bader Ginsburg, he will almost surely nominate an abortion opponent, and someone he believes will overturn Roe v. Wade.
The Biden reproductive rights platform stands in sharp contrast to Trump’s. Biden has pledged to restore funding to Planned Parenthood, to appoint judges who would protect Roe v. Wade, and to end the global gag rule.
“It’s all on the line. I know when people hear that they think, ‘You’re being a Chicken Little.’ But really: The sky is falling. The sky is falling and people need to realize that.” —Jennifer Gunter, MD
Importantly, Roe v. Wade is not just about abortion rights. It’s a case that built on previous jurisprudence that established a right of sexual privacy. That right to privacy now extends to many realms, including the right to contraception and the right to have sex with a consenting adult of the same gender. If Roe is overturned, it’s not just abortion that could be outlawed, and it’s not just abortion rights that will be rolled back: It’s an entire category of sexual and reproductive rights that are currently protected, but may not be if the Supreme Court invalidates Roe. For people who value contraception access, legal abortion, and LGBTQ+ rights, “it’s all on the line,” Dr. Gunter says. “I know when people hear that they think, ‘Oh, you’re just being hysterical,’ or, ‘You’re being a Chicken Little.’ But really: The sky is falling. The sky is falling and people need to realize that. And there’s a narrowing window of time to do something about it.”
The differences between Trump and Biden here are not just about politics. Abortion is one of the most politically contentious issues in the United States. Those who oppose abortion rights argue that embryonic and fetal life deserves the utmost protection, and that the right of an embryo or fetus to live trumps any claim a woman has to decide what happens inside her uterus. Those who support abortion rights argue that a woman’s sovereignty over her own body is of paramount interest, and that she—not the government—should get to decide whether she remains pregnant or not.
What is often missed in the political debate, though, are the very settled public health questions. The legal status of abortion has very little bearing on the abortion rate—women have abortions whether the procedure is illegal or not, but procedures tend to be much more dangerous when they are illegal, which means more women are injured or killed when abortion is outlawed. What does decrease the abortion rate is access to reliable contraception, especially long-acting methods like IUDs, which could become harder to get under a conservative president and a more conservative Supreme Court.
The physical and financial impacts of not being able to have an abortion when you need one are significant and well-documented. In the U.S., women who want to end their pregnancies but are denied abortions are more likely than women who were able to get abortions to be living in poverty years later; they are more likely to remain in abusive relationships; and their existing children wind up worse off. Already, abortion and even contraception are difficult for many American women to get. A Biden presidency would lower the barriers to preventing a pregnancy and ending one; a Trump presidency would raise them further.
One of the biggest questions voters always have is, “How will this presidency affect my pocketbook?” When it comes to Trump vs. Biden, it depends on how fat your pocketbook already is.
“In Biden’s proposal, he does talk about raising taxes on corporations, so that will impact business owners,” says Sylvia Kwan, Chief Investment Officer at Ellevest, an investment and financial wellness platform aimed at women. “His plan raises taxes on the wealthy, moving the current highest marginal tax rate back to 39.6 percent, and raising taxes on capital gains rates—not for everybody, but for those earning a million dollars or more.” For most Americans, their tax rate would remain the same. If the Biden proposal were carried out—a big if—the corporate tax rate would increase from 21 percent to 28 percent, and individual taxes would go up for the very highest earners: Single people making more than half a million dollars a year, and married couples collectively earning more than about $600,000. Families making less than $400,000 per year (most American families) would not see their taxes increase. And in turn, the billions in dollars of revenue from raising taxes on corporations and the wealthiest Americans could help pay for things like health care, childcare, education, and housing, all of which are financial drains on the middle and working classes.
Still, some critics worry that raising taxes could hurt the economy, which would in turn hurt many Americans’ bank accounts. Kwan says these concerns may be misplaced. “Higher taxes don’t necessarily mean poor market returns,” she says. “In the 1950s, there were very high tax rates—80, 90 percent, which most of this generation would find pretty astonishing. But there were also high market returns in that time. And in the 2000s, we had very low taxes, and not great market returns.” And in any event, “there’s a lot of talk about taxes and who’s going to raise and lower them, but there are so many other factors that influence both the markets and financial wellness other than just taxes,” Kwan says.
Americans now hold more than $1 trillion in student loan debt; more than 44 million Americans are paying off student loans.
One of those factors is debt, and for young Americans, student loan debt in particular. Americans now hold more than $1 trillion in student loan debt; more than 44 million Americans are paying off student loans, which average more than $30,000 per borrower. Neither candidate is offering the kind of expansive student loan debt forgiveness proposed by Democratic primary candidates Bernie Sanders and Elizabeth Warren. But it is very clear that Biden’s plan is much more generous to borrowers than Trump’s, and Trump’s plan could put those with student loan debt in an even more financially precarious position.
Under Biden’s plan, tuition would be free at some state schools, and reduced at community colleges and historically Black colleges and universities. His proposal would also cancel undergraduate student debt for graduates of public colleges and historically Black colleges, and give all student loan holders $10,000 in debt relief. He has pledged to clean up the disastrous public service loan forgiveness program, which promises to erase the debt of people who work for at least a decade in public service and continue to pay their loans on time during that period, but under Education Secretary Betsy DeVos has rejected 99 percent of applicants. Biden would also decrease the percentage of one’s discretionary income that has to be directed to student loans under an income-driven repayment plan, reducing it from the current 10 to 20 percent down to 5 percent; only undergraduate loans, though, would qualify. And any amount forgiven after 20 years wouldn’t be taxed—as it stands, even if your loans are forgiven after years of income-driven repayment, you still owe taxes on whatever you didn’t pay off. Biden would additionally increase educational grants, and make it easier to discharge student debt in bankruptcy.
The Trump student loan plan is thinner and less advantageous to students and loan-holders. Like Biden, Trump has proposed revising income-driven repayment plans, but he would require borrowers to spend 12.5 percent of their discretionary income on their loans. He would narrow repayment windows from the current maximum of 20 years for undergraduate loans and 30 years for graduate loans down to 15 years for undergrad and 25 years for grad school—meaning that the amount of money you’d be on the hook for every month would increase. He has pushed to get rid of federal subsidized student loans (loans that don’t accrue interest until after graduation and are given to students according to financial need) and instead require students to rely on unsubsidized loans, where interest begins to accrue immediately. Because COVID-19 pushed so many Americans to the financial brink, Trump has hit pause on federal student loan payments and interest through 2020, but has not offered any debt relief.
Then there’s Social Security, “which sounds like a really strange thing to tell people in their 20s to worry about, but they should worry about it,” says Helaine Olen, co-author of The Index Card: Why Personal Finance Doesn’t Have To Be Complicated and an opinion writer for the Washington Post. Trump has proposed eliminating the payroll tax, which is what pays for Social Security. He has already hit pause on payroll taxes because of COVID-19; if that change was made permanent, experts worry it could leave Social Security coffers empty as early as 2023. “It’s not simply your retirement” that would be put at risk, Olen says; it’s your financial health now. About half of people over the age of 65 would live in poverty or close to it without Social Security. The program doesn’t just promise young people that we can retire in the future, “but it is also why you don’t have to support your parents when they retire,” Olen says. A hit to Social Security now would mean that a lot of young adults are suddenly stuck footing the bill for parents who thought they would be covered into old age.
Questions about any given president’s impact on individuals’ financial health, Kwan says, should be tempered by the understanding that “generally, if you are investing for the long term—which we highly recommend that you do—who is in the presidency for four years or even eight years isn’t going to have as much impact as things that we all know lead to successful investing, like saving more, and the power of compounding.” But that doesn’t make the shorter-term impacts negligible.
“It’s hard to put it more starkly than to say that this is a life and death issue, and the future of the planet is at stake,” says Ayana Elizabeth Johnson, PhD, a marine biologist, founder of the Ocean Collective, and co-editor of the anthology All We Can Save. “I don’t know if our ecosystems can withstand another Trump administration. And of course we depend on nature for our own survival.”
The Trump approach to climate change has been to treat environmental protection and conservation as threats to corporate profits and jobs. His comments about climate change have been inconsistent to the point of incoherence, at times calling it “mythical” and a “hoax,” and at others declaring himself an environmentalist. At the policy level, his priorities are clearer. He withdrew the U.S. from the Paris Climate Accords. His administration has rolled back 100 different environmental protection regulations, including those aimed at regulating carbon emissions and reducing air pollution, and he is still trying to allow offshore oil and gas drilling off of most of America’s coasts. The Trump administration says that environmental regulations are often burdensome and duplicative, and that they “hamstring American businesses.” Removing them, they say, saves companies billions of dollars a year.
“I don’t know if our ecosystems can withstand another Trump administration. And of course we depend on nature for our own survival.” —Ayana Elizabeth Johnson, PhD
This of course affects the health of the planet, but also the health of all of us who live on it—it’s tough to be physically well if you’re breathing polluted air, eating fish from polluted waters, or at risk of losing your home because of fires or flooding. And, Johnson says, “the health of the planet doesn’t affect everyone equally. Communities of color and low-income communities tend to be hit first and worst by climate change.” That is particularly acute when it comes to natural disasters: Those who lack resources often can’t leave, and are slower to recover, if they recover at all. But it also manifests in the physical body. “We see this with the intersection with COVID,” Johnson says. “Communities where power plants are located, who have already been exposed to polluted air and have weakened respiratory systems, are at risk to more extreme forms of COVID.” Asthma, influenza, even cancer: There are a great many diseases that may be caused or exacerbated by climate change.
Biden and Trump “couldn’t be more polar opposite when it comes to the health of the planet,” Johnson says. While many environmentalists critiqued Biden’s climate plan during the Democratic primaries, Biden the nominee gave it an overhaul. The Biden climate plan is now a $2 trillion endeavor that aims to end dependency on fossil fuels and move fully over to renewables by 2035, while investing in creating green jobs, particularly in the manufacturing sector. And 40 percent of the benefits in his plan go to traditionally under-served communities that are often on the front lines of climate change.
Perhaps the most heartening part of Biden’s plan, Johnson says, is the degree to which it reflects a willingness to change his mind after learning more and talking to experts, and a dedication to solving the problem instead of being right. “He’s been pulling from the best ideas raised in the primary from other campaigns: from Inslee’s plans, from Warren’s plans,” she says. “And that’s what we want to see: everyone carrying the best ideas forward, no matter who initially drafted them.”
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