Over the last 15 to 20 years, health care has gone through quite a few changes. Drastic government initiatives for health insurance mainly started with President Lyndon B. Johnson’s Social Security Act of 1965, which brought about what we now know as Medicare and Medicaid.

Since then, the actions of both the government and the private sector until the 1990s focused on lowering costs across both sectors. This was a difficult feat due to a previously private but universal service suddenly becoming a joint responsibility; and therefore, a joint cost.

Much of the time, partisans see health care as an overwhelmingly political question. But for many, especially non-partisan and independent voters, health care is an overwhelmingly personal question.

So let’s look at the relationship between health insurance and the independent voter for the last few years — the good, the bad, and the confusing — and figure out what health care really looks like when we put partisanship aside.

Health Insurance and the Independent Voter

Where were we by 2000?

By 2000, it was more possible to buy affordable health insurance, even with pre-existing conditions, than it had been even just 10 years ago. In 1997, through the Children’s Health Insurance Program, the Clinton administration managed to pass coverage for dependents up to age 19, if the family did not qualify for Medicaid.

The Medicare Prescription Drug Act of 2003

The next president to make an immediately felt change in the health care world was President George W. Bush, with the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. This law applies only to those currently receiving Medicare. With a specific card, prescription drugs can be discounted up to 15%. They can also be reimbursed 75% up to $2,250.

So far, so good for the independent voter. President George W. Bush’s law was not a campaigning point, nor did it apply across the board. The game changed, however, with the Affordable Care Act of 2010.

The Affordable Care Act of 2010

The Patient Protection and Affordable Care Act of 2010 is also known as the Affordable Care Act (ACA) or colloquially as Obamacare. It was one of President Barack Obama’s election standards, upheld by Democrats and challenged by Republicans. Independent voters, on the other hand, were caught up in the partisan end result — both the positive and the negative aspects of it.

First, Medicaid, or the government health insurance for those the federal government defined as “poor,” was expanded to include more families. For those just above that definition of poor, health insurance was subsidized. Over time, up to 32 million more Americans could receive health care coverage through this.

Second, our health care premiums are now tax-exempt whether we or our employers are paying for them. Before the ACA, the tax exemptions only applied when our employers were paying for us — putting any Americans between jobs in quite a health care bind. Eventually health insurance premiums above a certain price would be taxed, providing more income for health spending.

Third, the government tried to even out the premium-to-risk ratio (higher sickness risk, higher premium to pay) by mandating a flat-rate premium across the board. To do this, it restricted the ability of insurance companies to reject individuals based on their previous or current state of health. To reduce the costs on the health care provider, all individuals are required to enroll in health insurance, or pay a tax penalty.

What are the pros and cons so far?

First, expanded Medicaid coverage is something of a step toward universal health care. Even from a non-partisan perspective, this is a practical approach, particularly considering the European models. However, it’s bound to raise government costs in the first few years, which means it takes out of our taxes.

Second, tax-exempt health care premiums are a win wherever you look.

Third, a flat-rate health insurance premium across the board sounds good. Even the requirement for all individuals to enroll in health care has had an unexpected benefit, as children under the age of 26 can now be covered on their parents’ health insurance.

This is part of the attempt to balance the healthy with the sickly in a health insurance pool. However, keeping the healthy in the insurance pool is proving to be a bit of a challenge.

You win some, you lose some with the Affordable Care Act, but since universal health care is as close to a universal good as we can get, we might see it worth it in the long run.

The Trumpcare Act of . . . ?

President Donald Trump and certain Republican senators and congressmen have been attempting to repeal or amend the Affordable Care Act since his term started. In fact, like President Obama, the overhaul of the health insurance system was a campaign standard for President Trump.

The main goal of this overhaul would be to make health insurance competitive again by marketplace standards, and thus to improve the quality of health care.

From the perspective of the independent voter, what do we stand to gain? What do we stand to lose? Does this make a difference in the long run?

First, most of the attempted repeals to the ACA have to do with delaying certain provisions, or at least making them optional by state. Because of the high number of Americans who would lose insurance coverage, both houses of Congress have failed to pass any of these.

If President Trump’s initiatives push through we would gain, first, lower health care premiums — if we’re healthy and with no pre-existing conditions. We would also no longer need to pay a penalty if we are not enrolled in any health insurance plan.

If we worked in the health care industry, we would no longer receive cost-sharing subsidies from the government, and we can start operating more for profit.

We would stand to gain market-regulated health insurance plans, which usually guarantee better quality and competitive prices. But we would stand to lose a more predictable, government-regulated health care provision with expanded coverage and a flat-rate premium.

How Can We Enter the Discussion?

As non-partisan voters, our advantage is that of equal clarity on every side. We’re not “for” Obamacare only or “for” Trumpcare only; we are for a fair and equal government approach to health care.

Our role in the discussion is to provide research and insight built from observing international, national, and state health insurance systems. And when election time comes, our role is to vote according to what makes sense in our situation.