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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The attempted imposition of the notorious Obama-era “HHS mandate” on religious organizations, especially Catholic institutions, reflected an attitude that has been pervasive during Obama’s presidency, which is one of barely concealed hostility toward persons or organizations holding on to traditional religious beliefs. It should be the first order of business of the incoming Trump administration to rid the federal government of this attitude and the associated policies that flow from it.
The place to begin that process is with the HHS mandate itself. The mandate is a rule, finalized initially in 2013, that requires nearly all employers in the United States to provide all manner of free contraception in their health-plan offerings. The Obama administration went out of its way to impose this requirement even on many Catholic institutions, such as universities and hospitals, knowing full well that the requirement violated fundamental teachings of the church. It then provided only the narrowest of exemptions to the general requirement and fought every legal challenge trying to provide greater latitude to religious organizations or employers with religious sensibilities.
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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President Obama recently warned that if Congress junks the Affordable Care Act, “133 million Americans with pre-existing conditions” will be in jeopardy. That’s a phony figure, for several reasons. The actual number is roughly 500,000.
For starters, half of Americans get their insurance through an employer, according to the Kaiser Family Foundation. Another 34% are on Medicaid or Medicare. For all these people, pre-existing conditions are no barrier to coverage.
Pre-existing conditions mattered before ObamaCare only in the individual market, but even there few were affected. Many of these people with pre-existing conditions managed to get health coverage through the high-risk pools run by 35 states. Those pools covered about 225,000 people in 2011, according to the Kaiser Family Foundation.
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