President-elect Donald Trump outlined some facets of his healthcare program Thursday (November 10, 2016), largely following ideas he laid out during his campaign, from a repeal of Obamacare, his predecessor’s signature health law, to language indicating opposition to abortion.President-elect @realDonaldTrump outlined #healthcare plan including repeal of #Obamacare Click To Tweet
The brief, 310-word plan gives few details about how Trump will replace the Affordable Care Act, or ACA, except that it would include health savings accounts, and an ability for insurers to sell coverage across state lines, according to Bloomberg.
The document, posted Thursday on the presidential transition website, is the first look at Trump’s plan since the election. It includes protecting “innocent human life from conception to natural death” and gives states a big role in regulating health insurance and in running their Medicaid health-insurance programs for the poor.
“The Administration recognizes that the problems with the US healthcare system did not begin with–and will not end with the repeal of–the ACA,” according to the website.
The Trump document is similar to a March blueprint from the Republican president-elect’s campaign that endorsed a series of broad ideas popular on the right, including allowing insurers to sell plans across state lines, sending Medicaid funds as block grants to states and making tax-free health savings account part of an estate.
On his transition page Thursday, Trump hinted at softening the coverage guarantee for those with pre-existing conditions under the ACA, saying high-risk pools–state insurance programs for individuals who are sick or otherwise unable to get coverage–would cover those with large medical expenses who have “not maintained continuous coverage.”
Repealing the ACA, a law passed in 2010 that brought insurance to about 20 million people who previously lacked it, could leave those with pre-existing conditions without insurance.
The plan doesn’t address the rising cost of prescription drugs, which has been under intensifying scrutiny in the past year in the US, nor the possibility of re-importing safe, cheaper medicines from abroad, which was one measure he’d called for in the past. The document also doesn’t say whether Trump would retain some of the Affordable Care Act’s more popular provisions, including a rule allowing children to stay on their parents’ plans to age 26.
Trump is calling for a reform of the Food and Drug Administration “to put greater focus on the need of patients for new and innovative medical products,” and says he will “modernize” Medicare, the US health program for the elderly. Again, there were no details.
During his bid for the Republican nomination, Trump campaigned for stretches at a time without mentioning the ACA, and was vague about his approach, says Bloomberg. “Repeal and replace with something terrific,” he said in July 2015. ”I want to take care of everybody,” he added.
Trump’s attacks escalated toward the end of the campaign amid news of rising premiums on the exchanges. At his final rally on the eve of the election in Grand Rapids, MI, he called for “repealing and replacing the disaster known as Obamacare.”
Trump declared: “With Obamacare, premiums are surging, companies are leaving, insurers are fleeing, doctors are quitting and deductibles are going right through the roof.” A Hillary Clinton presidency, he warned, would “destroy American health care forever.”
More than 100,000 Americans rushed to buy health insurance under the Affordable Care Act last Wednesday, the biggest turnout yet during this year’s sign-up period. Unsurprisingly, it was the day after the election of Donald J. Trump, who has promised to repeal the law. Doesn’t this speak volumes on whether Obamacare serves the health needs of our traditionally uninsurable citizens? They apparently think so.
The figure, announced by the Obama administration, added to a “sense of whiplash” about the law, noted The New York Times, and underscored the magnitude of any change. Despite all the criticisms about the law coming from President-elect Trump and his allies, millions of people now depend on it for coverage.
Even the powerful healthcare industry, which invested hundreds of millions of dollars in preparing for business under the Affordable Care Act, is disoriented about what to do next–and scratching about for ways to avoid a big financial shock. A repeal of the act would mean the loss of millions of customers for insurance companies and a tidal wave of uninsured people in two hospital emergency rooms for basic care.
Industry executives say their first priority is to persuade Mr. Trump and the new Congress to replace the law with some way for people to continue getting coverage.
The problem is that, until now, top executives from the biggest insurers have not heard from Mr. Trump or his close advisers about his plans. In fact, the industry as a whole made no contingency plans for a Trump victory and does not yet appear to have developed a strategy.
Obamacare repeal is one Trump’s few proposals amounting to more than a detail-free promise of something “Yuge,” quips Bloomberg analyst Max Nisen. It’s also one of the few areas of wholehearted agreement between him and GOP congressional leadership.
If and when it will actually happen, to what degree, and the structure of any replacement are all unknown. But just about any move in this direction will hurt healthcare providers that have benefited from the law’s efforts to make health care more accessible.
Hospitals have had a pretty exceptional run with Obamacare, outperforming the market for years. Sales tend to go up when millions of previously uninsured people gain access to affordable health care. The once-inconceivable reality of a Trump presidency has evaporated those gains and more. After massively outperforming the broader market for years, hospital stocks are crashing back to earth.
Democrats, of course, will fight a repeal using every maneuver known, but it’s uncertain how much they can do. The big question is whether the law will be undone entirely, stripped of its least-popular provisions while keeping the popular parts, or morph mysteriously into what Trump says will be, “something really special.”
The first option is tough to imagine. Yanking health insurance from millions of vulnerable people is political suicide, and people cherish the ability to get insurance despite having pre-existing conditions, among other protections granted by the law. That doesn’t mean it’s not possible, says Nisen–we are in uncharted territory, after all–but you’d hope there would be at least some degree of moderation and focus on the human cost of these moves.
It will be a challenging and untidy balance to achieve; keeping the law’s less-controversial features and removing unpopular ones, such as the individual mandate, just can’t work, says Bloomberg.
It’s just math. Proposed replacement options, such as encouraging investment in healthcare savings accounts, interstate shopping for insurance, and block-granting Medicaid, are unlikely to be adequate, and likely to leave millions uninsured.
Regardless of which repeal or replace scenario transpires, hospitals and healthcare services companies stand to take a beat down. But that’s still just speculation at this juncture.
According to Bloomberg Intelligence, Obamacare accounted for about 10 percent of Ebitda for Tenet Healthcare and Community Heath in 2015, a number that might be higher this year. Whether that source of revenue erodes rapidly or over the course of a few years, both companies will suffer.
Harkening back to his business experience and acumen as a wheeler-dealer, Mr. Trump will likely use market solutions to address access issues and improve affordability as his default stance in health reform, says Forbes.
He hopes to empower consumers–who are facing increased personal payment responsibility–by requiring price transparency from all healthcare providers, including doctors, clinics, and hospitals.
He would allow individuals to fully deduct health insurance premiums payments from their tax returns, encourage tax-free Health Savings Accounts, and promote the Republican-standby of interstate insurance sales.
Trump’s campaign spawned more questions than answers, says Forbes. Our first indications of what to expect over the next four years begin with the actions of his transition team and the appointments he will make over the next three months.
After one heck of a wild ride this momentous, unprecedented (in countless ways) week–with some of us still hoping to awake from an inconceivable nightmare–it’s sinking in that all of us citizens have a duty to give the President-elect his fair chance to govern, at least for the next two years. He might just surprise many of us. I sincerely hope so.Steve's Take: @realDonaldTrump should have his fair chance to govern, he might just surprise us Click To Tweet
But my sense is that while he assuredly deserves his chance, I better shake off the cobwebs, buckle up, look in the rear-view mirror, take a deep breath and…(to be continued).