Hello world! Welcome to the first few weeks after America elected Donald J. Trump to be the 45th President of the United States. Are you still stressed/confused/planning to move/scheduling an appointment to get an IUD before it’s too late? Me too!
In a world upset, the candidate so many of us were sure would come in second came in first, and now we’re facing a reality in which the Executive, the Legislative, and most likely the Judicial branches of government will all lean conservatively.
In the past decade or so, we’ve made tremendous steps in the direction of liberalism with legalizing gay marriage and making healthcare affordable (ish?) and accessible to all. Thanks, Obama! But now what?
President Obama’s landmark achievement was the creation and enactment of the Affordable Care Act (ACA). The ACA made it illegal for insurance companies to exclude individuals with pre-existing conditions, made preventive health care free with insurance, and expanded Medicaid so millions of individuals (typically young people without children and with lower incomes) could finally access affordable coverage. There were dozens of other provisions, but I think those are the main components that made the law so valuable to so many.
During the campaign, Donald Trump vowed to repeal the healthcare law, making millions of Americans who recently secured health insurance very nervous. Here are 20 things you need to know about Donald Trump’s plans for health care…
Donald Trump ran, and won, on a campaign of repealing Obamacare
During his campaign, President Elect Donald Trump ran as the Republican nominee, on a platform of critiquing the Democratic leadership we’ve lived under for the past eight years. As such, one of his main promises was to repeal “Obamacare,” also known as the Affordable Care Act, which was signed in to law in 2010 and upheld by the Supreme Court in 2012.
His complaints against the law include “runaway costs” and “websites that don’t work.”
His campaign website laid out a plan for repealing Obamacare
Sort of — which is more than the Republicans who ceaselessly attacked the law had done before. Detailed plans on his ideas for what to do instead of Obamacare can be found on Trump’s website.
During the debates, and on the campaign trail, it was difficult to discern concrete plans between back and forth character attacks that left no time for policy discussions. The bullet points are vague, but follow suit with the Republican candidates Donald Trump ran against in the primaries.
But in the grand scheme of things, Mr. Trump’s healthcare plans came a little late
His health care plans are new in terms of long term campaign timeline. His healthcare ideas were not unveiled until after his Super Tuesday victory over Rubio and Cruz, and before one of the Republican debates.
The (relatively) last minute publishing of his health policies may mean two different things. It could mean that he was sitting on his plans, waiting to advance in the race before sharing them with America. Or it could mean that he really has no idea how complex the healthcare industry is, and threw these plans together once he realized his presidency might actually be a reality.
Either way, the late reveal of Obamacare replacement policies does not necessarily inspire confidence.
Donald Trump’s top three priorities are immigration, healthcare, and jobs
In a 60 Minutes interview with Lesley Stahl that aired on November 13th, Mr. Trump confirmed that during his presidency his top priorities will be immigration, healthcare, and jobs. This answer was in response to the question of whether he’d follow through on his promise to prosecute Secretary Clinton over her misuse of emails.
While Obamacare is not perfect, and has created difficulties for several in obtaining affordable insurance, it was a giant step in the right direction in terms of getting millions covered. Mr. Trump might continue to improve healthcare in America as one of his priorities, but he might also completely mess it up.
People are pretty freaked out
The Wednesday after the election, 100,000 people enrolled in health care insurance under the Affordable Care Act. This is the largest surge in open enrollees so far this season, and speaks volumes of the importance of the law and its implications for so many.
Millions of people have taken advantage of the law to obtain health insurance, several million of which did so for the first time ever. A lot is at stake under a Trump presidency, and nothing is more motivating than fear when it comes to taking action and (re)enrolling for another year of health insurance.
Whatever change will happen, it won’t be soon
The legislative process is SLOW, y’all. It’s one thing to be gung-ho on the campaign trail, but it is another thing entirely to actually be running the show. Even with a Republican congress, there are still enough Democrats to create a filibuster. Additionally, Trump’s plan for healthcare reform leaves a lot to be desired, especially in the face of repealing Obamacare in its entirety.
Writing a clean replacement of the law, and getting it passed, is likely to take time, meaning that for 2017, your health care insurance through the Marketplace will remain untouched. Health care leaders don’t estimate changes until 2018 at best.
If you’re under 26, and on a parent’s health insurance plan, relax
In the 60 Minutes interview, Donald Trump announced, for the first time, that an aspect of the Affordable Care Act he currently finds value in is the provision that allows children under the age of 26 — by which time you’re really not a child anymore, are you? — are allowed to stay on their parents’ health insurance plans. It is something they “are going to try and keep.”
If you’re under 26, this is probably great news for you! Congrats!
Donald Trump is also a fan of protecting those with pre-existing conditions
Calling this provision one of Obamacare’s “strongest assets” in his conversation with Lesley Stahl, Mr. Trump announced he will also be aiming to keep this provision intact. While so important to millions of individuals who had previously found it difficult to obtain health insurance, this clause has also cost insurers a lot of money.
It’s likely a sign of good-faith that despite the financial implications of insuring those with pre-existing medical conditions, Donald Trump is (currently) opting to value the human implications of denying healthcare to those who need it most.
His stance on rising costs of pharmaceuticals has already changed
One of the bullet points of health care reform on his campaign website urges Congress to move away from special pharmaceutical interests and for barriers to entry into the free market to be removed. This would allow consumers to access drugs from overseas, hopefully bringing safer, more reliable, and more affordable products to the everyday American, which is cited as one of the top problems Americans want fixed.
However, that focus seems to have disappeared on his official transition website. Interestingly enough, Vice President Elect, Mike Pence’s political career has been continuously supported by the big pharma corporation Eli Lilly & Co., based in Indiana. Mike Pence now leads the Trump transition team.
There should be no gap time
Once again, a huge insight into Donald Trump’s actual policy plans came during his big 60 Minutes TV Special. It provided a long past due opportunity to discuss key issues, especially since the nation decided this was the person they wanted.
During the segment on health care, Donald Trump promised that the repeal and replace would happen at the same time. He promised there wouldn’t be a single even be a single day gap, saying that “we’re going to do it simultaneously.”
Medicaid beneficiaries are at risk
In his promise to repeal the Affordable Care Act, which expanded Medicaid eligibility to 15.7 million people beginning in 2014, Mr. Trump is threatening to cut spending in the state-federal insurance program. Medicaid is the primary health insurance program for low-income individuals, which creates difficulty around changing the program as it would carry serious financial consequences to states, hospitals, and health providers who serve the low-income population on Medicaid’s dime.
Trump and House Speaker Ryan have endorsed the idea of making Medicaid a block grant program, as opposed to an entitlement program, which would give the states more power in designing their own programs. The block grant proposal has been around for 25 years, but has consistently been met with legislative battles, which is not likely to change this time around either.
If repealed, 22 million will be uninsured
Independent of any replacement plan Donald Trump may or may not have, a repeal of the Affordable Care Act will create an upheaval in the health insurance coverage of over 22 million individuals. State marketplaces, where several individuals purchase their health insurance independent of any employer sponsored coverage will close, affecting about 10 of those 22 million individuals.
All this is to say that this isn’t a game. Health insurance is frequently politicized, when it really needs to be people-ized. It is an industry, sure, but it can also be the difference between life and death for so many individuals across the nation, and should be treated with the gravity it deserves. Don’t repeal something if you can’t replace it with a serious option.
Trump estimates a savings of $11 billion by getting immigrants off our healthcare
Donald Trump is notorious for his language around immigrants, and it was one of the more polarizing aspects of his campaign, to say the least. His healthcare reform plan is not exempt from his immigrant-bashing rhetoric.
Should America “simply enforce” immigration laws and restrict access to America, Trump says we could save $11 billion dollars a year.
A repeal would cost $350+ billion
However, what his campaign site failed to mention was that an Affordable Care Act repeal would also increase the deficit by $353 billion over a decade, so still around $35 billion dollars a year – which is still 3X more than what we would be saving by cutting immigrants off from healthcare coverage.
In short – WTF?
He wants to allow insurance to operate beyond state lines
Let’s talk more about the meat of his reform plans. One of his main points is to modify existing laws prohibiting the sale of health insurance over state lines.
As long as a health insurance plan complies with state requirements, vendors should be able to sell to those residents. This would ideally increase competition, keeping monthly premiums for consumers low and satisfaction high.
He wants to allow deductions for health insurance premiums from tax returns
One of the most consequential proposals of “Trumpcare” is to allow individuals to deduct health insurance premium payments from their tax returns. If you’re not a huge tax nerd, you’re probably like, okay?
Basically, if you make a lot of money, this is a great new tax break for you. However, if you don’t make a lot of money, health insurance will remain unaffordable, and your monthly premiums will likely be higher than what you owe in taxes.
In other words, this provision might not help a lot of everyday people. It would also deprive the treasury of revenue, creating another set of financial consequences to address.
He’s a fan of health savings accounts (HSAs)
Health savings accounts have been a long time Republican favorite for health care insurance design. Ideally, healthcare consumers would feel a greater sense of responsibility in the healthcare market, seeing as how they were spending from their own account, which would lead to demanding lower prices for health care and drive down health care spending. They also provide convenient tax shelters for the wealthy.
However, studies show that when it comes down to it, people have a difficult time differentiating between care they do or do not need, leading to individuals skipping routine prevention health care visits until an emergent situation arises, which costs even more than a well-check would have. Finally, HSAs also discriminate against the low-income, who don’t have spare change to be socking away in the first place.
The greatest consumer benefit would be to create competition among insurance companies
At this point in time, the greatest thing Donald Trump could do for American healthcare would be to design policies to drive up competition and drive down monthly premiums. As it stands, his published health care reform plans only scratch the surface in addressing this top concern, and instead seem to focus on rocking the boat for consumers instead of health insurance giants.
Obamacare is not perfect, but to be honest, we have yet to see any health insurance system without its own set of faults. The best we can hope for is to build off of what is already working, which is the opposite of a complete repeal.
Canada’s health care isn’t perfect either
For those of you interested in moving north to escape a Donald Trump presidency, you should know a few things about the health care they have up there.
Their health system is publicly funded and administered by the provinces by guidelines set by the federal government. The average wait time for a medically necessary service is four and a half months, which comes with additional consequences in of itself. In other words, move at your own risk.
No matter what, enroll now at Healthcare.gov. Get it and use it.
Do not let the incoming administration scare you away from getting the health care you need, want, and deserve. Enroll today at Healthcare.gov or through your employer, and make sure to use the insurance you do get in the New Year — before you potentially lose it.