Trump’s replacement plan for the Affordable Care Act is incomplete at best. To date, the president-elect has not offered a concrete plan to replace Obamacare, which makes it difficult to determine if his ideas about healthcare reform are actually viable. President Obama signed the ACA into law nearly seven years ago, but it took years of political maneuvering to get the bill in good enough shape to pass both the House and Senate and make it onto the president’s desk. Change doesn’t happen overnight. Trump appears to expect a miracle when it comes to healthcare reform, but is his strategy enough to overcome years of progressive legislation?
Breaking Down Trump’s Plan
On his campaign website, Trump outlined his 7-point plan to reform the American healthcare system. Trump’s site is rife with accusatory language, which isn’t surprising given the general disdain that most Republicans have for Obama’s signature healthcare law. The war on healthcare is about more than meeting the needs of millions of Americans who lack health insurance. It’s also a reaction against the work and opinions of President Obama and the Democrat population in general.
This self-propelling healthcare war between the Democrats and Republicans in the U.S. could be enough to either completely shut down Trumpcare before it has a fair shot, or further divide the country than 2016’s presidential election already has. It will be hard to completely ignore the growing tension between the two largest political parties in the U.S. Emotional controversy aside, Trumpcare has made a few statements that are intended to lower costs for healthcare. These statements have been published on Donald Trump’s own website and should be taken literally until amended by his healthcare reform team. Let’s look at the viability of Trump’s plans for the healthcare system.
|Trump’s Proposal||Is it Viable?|
|Eliminate the individual mandate||On its own, eliminating the individual mandate that requires people to have health insurance would work – if Trump wasn’t also in support of covering people with pre-existing conditions and keeping health insurance affordable. The mandate ensures that young, healthy people sign up for insurance, and their premiums offset the cost of care for older, sicker individuals. Cutting out the mandate will make providing affordable coverage more difficult and maybe impossible for people with pre-existing conditions.|
|Allow insurers to sell across state lines||Insurers are already allowed to sell health insurance across state lines as long as states agree to the exchange. No one does, however, because selling across state lines is complex, expensive and overly burdensome on insurers and beneficiaries alike. Opening up competition is a viable option, but it could backfire when insurers choose not to participate.|
|Increase tax deductions for individuals||For people who itemize their tax returns, taking a deduction for medical expenses is already an option provided that expenses exceed 10 percent of your income. Trump wants to increase tax deductions because employers already take a similar deduction. This is also a viable plan for many people, but it’s not particularly useful to people who don’t itemize. Nearly 69 percent of taxpayers take a standard deduction.|
|Expand the use of health savings accounts||Health savings accounts (HSAs) can be used with high-deductible health plans to help people save money for medical costs. There are caps in place under the ACA, and most people don’t use HSAs because they require diligent saving. Most Americans don’t have the resources to utilize them. Trump wants to expand HSA incentives to make them more attractive to more people, but this isn’t a viable idea when 69 percent of Americans have less than $1,000 saved up for emergencies. It’s just not a plan that benefits your average consumer.|
|Encourage price transparency||Democrats and Republicans agree on one thing: The healthcare industry can be convoluted, especially when you’re trying to make sense of costly medical bills. Trump is seeking to encourage price transparency, a goal he shares with the ACA. It’s a viable plan if there are practical measures attached to it. So far, details have not been released on how he intends to foster transparency.|
|Fund Medicaid using block grants||Trump and Republicans in Congress have proposed changing the way that Medicaid gets funded. Right now, it’s a dollar-for-dollar matching program, which means the federal government matches (or exceeds) the money that states spend on their Medicaid programs. Block-granting would mean that the federal government would allot a portion of funds to each state, and states would spend that money as they see fit. This may be a viable idea if states can innovate and build their programs to cover people who need care. But it runs the risk of leaving millions of low-income Americans out in the cold if their states can’t afford to expand coverage.|
|Remove barriers in the drug industry||The pharmaceutical industry holds the healthcare sector in the palm of its hand in many ways, primarily due to powerful lobbying. Trump wants to put some control back into the hands of consumers by allowing them to import drugs from other countries as long as the drugs are safe and reliable. This could be the most viable option of Trump’s proposals, and it’s a shared idea among Democrats and Republicans. Removing barriers to the free market in the drug industry may have a positive long-term impact on the healthcare industry as a whole.|
Since he won the election, Trump has changed his mind about certain aspects of the ACA. He likes the provision that protects people with pre-existing conditions, and he wants to make sure that young adults up to age 26 can stay on their parents’ health plans. But these ideas conflict with other aspects of Trump’s reform plan. Experts predict that Trumpcare could leave more than 20 million people without insurance. They also point out that many of these provisions are too vague to decipher at the moment.
Millions of Americans are uneasy about what Trump has proposed. In its rawest form, Trumpcare will not be viable for people below a specific tax threshold. If amended to include lower- and middleclass populations, Trumpcare may eventually turn out to be a practical replacement for Obamacare. Because there are so few details available, there’s really no surefire way to determine whether or not Trumpcare is viable until it has actually been implemented, a fact that continues to concern voters and politicians alike.