While much about a Trump Presidency remains relatively unclear, one thing is for certain—the way healthcare is handled in the US today will change.
One of Mr Trump’s biggest issues while on the campaign trail was his promise to “Repeal and Replace” Obamacare.
WILL PRESIDENT-ELECT TRUMP KEEP ANYTHING FROM OBAMACARE?
–Based on his most recent comments on 60 Minutes, it appears that Mr. Trump will keep a very important provision that ensures that those with pre existing conditions will remain insured. If we do not keep this provision, we will go back to the days when insurers could discriminate against individuals with chronic medical problems by either denying coverage or making coverage far too expensive. It is essential that this stay in place in order to make sure that ALL Americans are covered (in an affordable way)—regardless of what chronic medical problems they may have.
–Mr. Trump has also indicated that he will keep the provision that allows young adults to stay on their parent’s plans thru age 26. I think this too is vital. Young adults are building careers and often are scraping to get by from a financial standpoint while they complete higher education and low paying internship training programs. I think allowing these individuals to stay on their parent’s plans only makes sense. It alleviates a significant financial burden during the time in which they are developing careers and working towards education goals in order to make significant contributions to society.
WHAT IS LIKELY TO CHANGE IN HEALHTCARE?
This is where the water gets a little “murky”. Trump says that he will “Repeal and Replace” Obamacare—this may be difficult from a legislative standpoint unless the Republicans invoke the Harry Reid approach of the “nuclear option” in Congress. Currently it will take 61 votes in the Senate in order to repeal the legislation. Based on the partisan politics we are likely to see in Congress, this is unlikely to happen. Alternatively, Trump can “starve the ACA” by signing a bill similar to the one that was sent to Obama a few years ago that essentially defunded the ACA. (Obama of course vetoed that bill).
Over the last year, President Obama has been using Treasury monies that were meant for tax refunds to pay back insurers in the exchanges that have had high cost patients. While the ACA provided for these payments, Congress did not fund this provision so Obama has been re-appropriating money from other sources. There is a court case pending that is likely to stop this action. However, Trump can stop it immediately on Jan 20th. If this happens, I worry that more insurers are likely to pull out of the exchanges and the ACA will continue to slowly implode.
ARE THERE ANY SPECIFICS FROM TRUMP’S PLAN FOR HEALTHCARE?
While it is likely that any plan will involve the Republican/Ryan proposal that has been crafted for more than a year, Mr Trump has discussed a few specifics during the course of the campaign. It is unclear at this point just how much of this will be implemented.
- Allow insurers to sell insurance across state lines
–By allowing free market competition, Trump argues that competition for patients by insurance companies will lead to better service, lower prices and more patient satisfaction
- Allow individuals to deduct healthcare premiums from taxes
–By putting more $ in individual pockets, patients will be better able to afford healthcare
- Allow individuals to set up Healthcare savings accounts (HSAs) tax free money
—tax free accumulation for healthcare spending
- The individual and employer mandates will be eliminated
—Allow individuals to CHOOSE if they wish to purchase health insurance
5. Price transparency for doctors and hospitals
–Prices for common surgeries and services vary widely by geography and hospital. By requiring transparency, patients can shop around, using both quality and price data to determine the best place for them
–This will prevent gouging by certain hospital systems.
- Begin a Block grant to states to deal with Medicaid
— The federal government would send money to the states. It would then be up to the states as to how to use the money to cover the citizens. This may not be good as in some states it is likely to lead to decrease payments to docs and hospitals and may leave more low income Americans without adequate care
- Streamline the FDA and allow Americans to purchase prescription drugs from other countries.
–Currently the US pays far too much for drugs that can be obtained in Canada and elsewhere for much less. Why should the US pay all of the R and D costs for the world?
- Privatize Medicare—Other Medicare changes
–Provide citizens with a choice—use medicare dollars to see a medicare doctor or use that money to pay for private doctor that does not take medicare. May result in more out of pocket expenses for seniors.
–Allow medicare to negotiate drug prices—lower costs to Federally sponsored healthcare plans
Ultimately we must put a healthcare plan in place that will cover all Americans and we must make sure that the plan allows for low costs and easy access. However, I do not think this will be a “quick fix”. If there is no good replacement plan I am concerned that there may be 25million new uninsured Americans. However, many of these while listed as insured, are currently functionally uninsured due to limited access, high copays and premiums and deductibles. It is my hope that Congress will work quickly to craft a fiscally responsible healthcare plan that works for ALL Americans—and allows doctors to be healers once again.