This post was originally published on 9 November 2016 in http://www.healthpopuli.com/.
It’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities.
Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including:
- Extending health insurance to dependent children up to age 26
- Closing Medicare’s “doughnut hole” (for Medicare Part D which covers prescription drugs for older Americans)
- Covering people with pre-existing medical conditions
- Covering preventive services, and
- Providing subsidies that lower the cost of insurance.
What nobody likes is the direct consumer cost of health care — ACA’s lack of affordability, which was predicated on a competitive insurance marketplace and near-universal sign-ups for health insurance bolstered by a mandate for consumers to purchase insurance. Without these pillars in place, insurance companies have pulled out of local markets where they cannot be financially viable, leaving many consumers with only one choice for health insurance purchasing. Monopoly power in a local market means higher prices. Couple this with millions of consumers opting out of buying health insurance, leaving health plans with a sicker, generally older population to serve. Actuaries in health plans like a more standardized population with young, older, healthy, sick, and demographically diverse to be able to forecast utilization of health care services and, ultimately, the medical loss ratio (that is, patients’ costs incurred in the health plan).
Repeal-and-replace in Donald Trump’s healthcare world could result, in the short-to-medium term, in about 20 million Americans losing health insurance. The Commonwealth Fund estimated that this could increase the Federal budget deficit by between $330 bn to $550 bn over 10 years. (more…)