Consistency among GOP or Democratic candidates is difficult to find, except with regards to health care policy. While Bernie Sanders and Hillary Clinton on the Democrat side want to protect and enhance Obama care, the Republican candidates, to a person, want to “repeal & replace” the Affordable Care Act.
Republicans argue that repealing the legislation, which has provided health insurance to 20 million Americans is justified based on unsustainable costs, it’s unpopularity and/or the law’s anti-competitive, anti-free market features. Even if you are vehemently opposed to Obama care, for the purpose of planning a Republican led future, the fundamental question is, “Replace ACA with what?”
On this question, there is scant evidence. None of the Republican candidates have proposed or outlined anything like a comprehensive plan to replace ACA. Does this mean that, were a Republican to be elected President, that suddenly tens of millions would be without health insurance? It is plausible. What is more likely, were a Republican to be elected, is that the sheer impossibility of accomplishing “repeal and replace” would stop him, like charging, full tilt into a mile square cube of Jell-O.
Surprisingly, Mr. Trump has the most comprehensive healthcare policy documents, even though these are simply a set of bullet points. Mr. Trump speaks glowingly of the single-payer health care system in Canada and Scotland. It should be noted that in both countries delays to access healthcare are so severe that in Canada provincial agencies routinely contract with providers in the United States, and in Scotland the national system has been under pressure for decades to reduce wait times and improve access.
Another cornerstone of most GOP candidates’ healthcare platforms is enabling healthcare insurance companies to sell policies across state lines. (“Most” because Gov. Kasich has no published policy statement on healthcare at all, and this time.) On the surface of it, the idea that health insurance providers, free of the state-by-state insurance commission requirements could lower costs, offer plans across the country, increasing the pool of covered lives, reducing costs and increasing consumer choice. Unfortunately, logic and reality depart at this point. Several states have offered out-of-state insurance companies the opportunity to sell within their borders, but none have accepted the opportunity. The idea that an inexpensive plan offered in a low-cost state such as Nevada could be offered to a consumer in New York City, overlooks the cost to the insurance company of recruiting participating provider networks in New York to serve that consumer. So selling insurance across state lines will remain a rhetorical plank, rather than a significant option to replace policies for 20 million covered lives.
The most disturbing concept is the state managed Medicaid block grant program proposed by Mr. Trump, and popular with many Republican mainstream conservatives, including Speaker Ryan. This policy purports to provide funds to state governments to care for the poor. The block grant policy would render millions of poor Americans ineligible for Medicaid, and make healthcare for the most vulnerable even less consistent state to state.
So the question of, “Replace Obama care with what?” will remain unanswered even up to and after the election. Those of us working hard in the healthcare sector deserve better than this, and we should demand more.