Debate Night: Read this before you watch Sanders vs. Cruz on CNN

Doctor: Obamacare has to go
Doctor: Obamacare has to go

Obamacare has made health insurance more affordable, Democrats argue. Some 20 million more people now have coverage thanks to the Affordable Care Act.

Obamacare has destroyed the American health care system, Republicans say. Its premiums and deductibles are so high that people feel they don't even have coverage.

Which is true? It depends -- Obamacare has helped some people, and it's hurt others. The sweeping health reform law contains numerous trade offs.

On Tuesday night at 9 p.m. ET, CNN is hosting a Town Hall with Senators Bernie Sanders and Ted Cruz to debate the merits of Obamacare and of repealing it.

Here are some things to think about as you watch.

Subsidies vs taxes

The law provides subsidies to low- and moderate-income Americans to help them afford premiums. Those with lower incomes can receive additional subsidies to reduce their premiums and deductibles.

But it doesn't do much to help the middle class afford coverage. And it taxes the rich, insurers, generous employer-plans and others to pay for financial help for those lower down on the income scale.

Republicans want to repeal the Obamacare taxes and provide tax credits based on age, not income, so all those buying policies in the individual market would get some assistance. These subsidies, however, likely wouldn't be as generous for older Americans and lower-income folks.

Related: Even as they repeal Obamacare, Republicans still have to fund it

Comprehensive coverage vs more choice

Obamacare requires insurers to provide more comprehensive benefits, including maternity coverage, prescription drugs, mental health and substance abuse benefits.

Some Americans, however, are now forced to pay for expensive benefits they don't want or need. For instance, couples in their 50s or 60s likely won't use the maternity coverage.

Republicans want to jettison Obamacare's benefits requirements so consumers have more choice of plans, but critics say it will be harder for those who want a wider array of benefits to find such policies.

Related: How Trump may cover Americans with pre-existing conditions

Covering pre-existing conditions vs requiring people to buy insurance

One of Obamacare's most popular provisions banned insurers from discriminating against people with pre-existing conditions. Insurers can no longer exclude or charge people more because they are ill or had a condition in the past.

This provision is paired with one of the most hated rules of Obamacare: The individual mandate that requires nearly all Americans to have insurance. The mandate exists to lure more young and healthy Americans into the market so they can help pay for the higher costs of the sick.

This balancing act has left Republicans in a bind. They have promised to both repeal the mandate and protect those with pre-existing conditions, but only for those who have been continuously insured. Those who haven't can be subject to higher premiums and exclusions or can be funneled to state-based high-risk pools, which provided spotty coverage in the past.

Limits on out-of-pocket spending vs. higher deductibles

Obamacare placed several limits on how much people would have to shell out for health care and required insurers to spend more. It capped out-of-pocket spending to $7,150 for individuals and $14,300 for families in 2017. It also eliminated the annual and lifetime limits that insurers often placed in policies.

With these protections come higher deductibles. Insurers have hiked deductibles to compensate for these other financial restrictions and to try to keep premiums down.

Republicans haven't specified whether they'd continue these provisions, though they have promised to lower deductibles by letting insurers offer a wider variety of policies.

Related: Health care battle cheat sheet: Democrats vs. GOP

Lowering costs for the old vs. raising them for the young

Under Obamacare, insurers can only charge older enrollees three times more than younger ones. This keeps premiums down for those ages 50 to 64. Prior to the law, there was no uniform rule, but a 5:1 ratio was more common.

However, this rule raises premiums on younger adults and is blamed for keeping more of these folks from buying coverage on the exchanges.

Republicans want to widen this band to 5:1, but that will mean higher costs for older Americans seeking coverage in the individual market.

Related: Why it's so hard to replace Obamacare

Expanding Medicaid vs the federal government footing the bill

The health reform law expanded Medicaid coverage to 11 million low-income adults. Some 31 states plus the District of Columbia have embraced this provision.

But to ease the burden for states -- Medicaid is one of their biggest expenses -- Obamacare called for the federal government to pay 100% of the costs of the newly eligible for the first three years. Federal support is tapering down to 90% by 2020.

Related: Major changes for Medicaid coming under Trump and the GOP

Republican lawmakers are not huge fans of expansion, but they have even bigger plans for the program. Many want to limit the federal government's financial responsibility by sending a fixed amount of funding to the states.

Personal Finance


CNNMoney Sponsors