In Healthcare, the Art of the Deal is Not So Artful

The Washington shenanigans continue as President Trump holds out the specter of supporting the bipartisan Alexander-Murray Senate bill which attempts to shore up the Affordable Care Act and set up a reinsurance fund for large claims. The president has also promised to back off his threat to cut off funding of cost-sharing subsidies. All this is predicated on passage of Republican-led tax cuts which includes elimination of the individual mandate. The CBO estimates are holding at over 13 million Americans losing coverage as a result, and there are a number of credible sources which put doubt on the CBO estimates.

Years ago, I read Trump’s “Art of the Deal.” Chess may be a game appropriate for real estate transactions but in this case, the pawns are real Americans whose access to healthcare is being whipsawed on a fast-moving seesaw. And a side act in the game is funding for the Children’s Health Insurance Program (CHIP) for families not eligible for Medicaid, but for whom coverage is unaffordable. Because Congress failed to re-appropriate federal CHIP funding, many states will need to send notice to families that coverage for their children will run out.

Most Americans will not feel the effect of these negotiations since the substantial impact is on individual insurance purchasers. However, those who are impacted are, or should be, concerned. Because the rates and plans for 2018 are already established, I think we are in the clear until open enrollment for 2019. By that time, the groundswell of uncertainty will likely become a significant midterm election debate. And hopefully, by then, we can make some progress on bipartisan improvement on this fragile system.

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