President-elect Trump continues to baffle his most ardent critics. A recent example is his declaration to Washington Post reporters on Saturday night that “We’re going to have insurance for everybody.” As Forbes opinion editor Avik Roy has pointed out, for at least 17 years, Donald Trump has been an advocate of universal coverage.
As is his prerogative (and evidently his wont), President-elect Trump offered no real explanation of what he meant by this. He assured us “they’ll be beautifully covered” but likewise reassured Republicans in Congress “I don’t want single payer.” So let’s take a moment to ponder how his words can be parsed. This is especially important given that his nominee to head the Department of Health and Human Services, Dr. Tom Price, “stopped short of saying all Americans should be covered” during his confirmation hearing yesterday.
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As the 115th Congress convenes and President-elect Trump prepares to take office tomorrow, our nation faces incredible challenges and opportunities. On health care in particular, the stakes couldn’t be higher, nor the path forward more clear. As leaders working on state-based policy solutions across the country, we have seen the impact of Obamacare on our communities up close. That’s why we’ve produced a report, being released today, on the need to unwind the law’s disastrous expansion of Medicaid.
Given the focus on the disastrous launch of the law’s insurance exchanges in 2013, many people don’t know that most of Obamacare’s coverage gains have come not through those exchanges, but through its new expansion of Medicaid to able-bodied, working-age adults.
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Shortly after the end of his inaugural parade, President Donald Trump issued his first executive order: instructions for the federal government to dismantle the Affordable Care Act “to the maximum extent permitted by law.”
The executive order is a powerful political statement about the health care law, one that directs agencies to “waive, defer, grant exemptions from, or delay” any taxes or penalties they possibly can. The order doesn’t give Trump any new powers, but does suggest that he wants to move quickly on dismantling major parts of the health overhaul.
“This order doesn’t in and of itself do anything tangible,” says Larry Levitt, vice president at the Kaiser Family Foundation. “But it directs federal agencies to start taking steps to use their administrative authority to unwind the ACA in all sorts of ways. This is a signal that the Trump administration is not waiting for Congress to start making big changes.”
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Here are the priorities an Obamacare replace plan should have:
1. It should get 60 votes in the Senate.
2. It should repeal and replace in one go.
3. Cover at least as many people as Obamacare.
4. Don’t leave poor people out in the cold.
5. Fight provider cartels.
6. Enable technology-driven innovation.
7. Nudge people away from employer-provided insurance.
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During the 2016 campaign, Donald Trump promised to begin repealing and replacing the Affordable Care Act on Day One of his presidency. Within hours of his inauguration, he put a small down payment on that promise, issuing an executive order instructing federal agencies to “take all actions consistent with law to minimize” the law’s economic burdens.
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Republicans have made a great deal of progress toward broad agreement on a general policy approach over the past half-decade. The GOP has been preparing for the opportunity to enact conservative health care reform for years, and it now faces both a party electorate and a health care system that will not allow for endless indecision. It is too soon to know what the final product will look like, and whether a series of reconciliation bills or some uneasy combination of partisan and bipartisan measures will emerge. But it does seem likely that a year of intense action on health care is beginning.
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Rep. Tom Price, President-elect Donald Trump’s choice to head the Department of Health and Human Services, faced a contentious Senate hearing Wednesday as Democrats questioned his ideas for the future of Americans’ health coverage and whether his personal investments in health-care companies presented conflicts during his years in Congress.
Price began by laying out central elements of his years-long attempt to replace the Affordable Care Act. In doing so, he signaled ways in which Trump’s more populist message could collide with the core beliefs of congressional Republicans. He told senators that “it is absolutely imperative” for the government to ensure that all Americans “have the opportunity to gain access” to insurance coverage.
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President-elect Donald Trump says the program he plans to institute as a replacement for the Affordable Care Act will “get private insurance companies to take care of a lot of the people that can afford it.”
“We’re going to have a plan that’s going to be great for people. And it’s going to be much less expensive. And you will be able to actually have something to say about who your doctor is and your plan,” Trump told Fox News’ “Fox & Friends” in an interview that was taped Tuesday and aired Wednesday morning. “We have to cover people that can’t afford it. And that’s what I’m talking about. And we’ll probably have block grants of Medicaid back into the states. … Nobody is going to be dying on the streets with a President Trump.”
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Two Republican senators are working on legislation that would let states decide whether they want to keep Obamacare or move to a different system. Sens. Bill Cassidy of Louisiana and Susan Collins of Maine both hinted on the Senate floor Tuesday about a bill that would preserve Obamacare, but only for states that choose to keep it. Cassidy said the bill would be essentially the same as a bill he introduced in the last Congress called the Patients Freedom Act. It lets states decide if they want to stay in Obamacare if it is working or leave. “The state could go with the alternative, which we will lay out, the state could opt for nothing — no Medicaid expansion and no help for lower-income folks — or the state could opt to stay in Obamacare,” Cassidy said.
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Donald Trump’s pledge to “repeal and replace Obamacare” was one of his biggest crowd pleasers. Moving forward on his broad replacement themes—expanding health savings accounts (HSAs) and state flexibility—could lead to some surprising and intriguing reforms.
During the campaign, Trump supported the familiar Republican themes of tax-free HSAs and allowing families to deduct health insurance premiums in their tax-returns. He pledged that “we must also make sure that no one slips through the cracks simply because they cannot afford [health] insurance.” This opens the door to a serious and conceivably bipartisan discussion about how to replace the complex structure of ACA subsidies and tax breaks.
In addition to redesigning subsidies, another element is an expanded role for states. The familiar Republican call to take the federal money for Medicaid expansion as a block grant and turn it into subsidies for families to buy private coverage has received plenty of the attention. But the broader theme of giving states much greater flexibility could become a different pathway to the goal of affordable and adequate health coverage for all.
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