I looked back to my November 9th, 2016 blog – yes, the day after the election. And then I reread President Trump’s powerful speech to Congress this week. Our president, it seems, really knows how to stay on track. He says exactly what he thinks over and over again and then tries to get it done. He is adding a little more detail on how he plans to carry out his agenda – but not much. Here is where I think he is headed:
He will eliminate much of ACA, including the exchanges, by 2019. The employer market will pretty much be unaffected. ACA taxes will be replaced by a limitation on the deductibility of health premiums on tax returns (possibly 90%). Medicaid expansion will be eliminated and instead, the federal government will encourage the states to chart their own course with block grants. Medicaid will, I think, ultimately pick up the slack for those who can’t afford care and for others age-based credits will be available to ease the new premium costs which will also be age-based. Individual coverage will be provided through a private market solution, with the old portability rules in place to allow the transfer from carrier to carrier. But, if you decide to forgo coverage, it will be costly. High-risk pools will be in place (and again this will vary by state) to provide some relief so no one will be left without a coverage option.
So that handles the access issue, but once again there is not much to address affordability. Healthcare costs continue to spiral upward and the Trump solutions seem to encourage consumerism with a push to HSA plans and some pressure on the pharmaceutical industry to lower their costs. I don’t think there would be much cost savings by allowing insurers to sell across state lines – insurance pricing is based largely on discounts and to get discounts an out-of-state insurer will need volume.
I agree that Obamacare was in a death spiral and this Trump plan should at least get more people into the system. He needs to do a lot of work on costs. But, I like the direction this is headed. And he still needs to get Congress and the health insurance companies to go along. I am thinking of one of my favorite comedies, “Old School,” and fear we may possibly be headed that way. Will Ferrell takes his clothes off and runs down the street naked screaming “we’re going streaking!!!” – only no one is following him down the road. Donald Trump naked is probably a bad visual, but unless we get everyone on the band wagon, the result isn’t going to be very funny.