We are in the early days of considering what Trump healthcare policy may mean. While there is a lot of uncertainty, there are signposts.
Impacts on cost and coverage
The Commonwealth Fund reports on the impact of Donald Trump’s proposals on costs and access to health insurance. The conclusions are that the uninsured would increase to 25 million, coverage losses would disproportionately affect poor and middle income, and out-of-pocket costs would increase. And because Trump’s platform does not describe how the changes would be funded, the Commonwealth Fund speculates that the deficit impact would be $0.5 billion to $41 billion. There is a significant amount of uncertainty about the details.
The pharmaceutical and healthcare services markets responded warmly to the news that Mr. Trump had beaten Hillary Clinton. Secretary Clinton’s platform includes controlling prescription drug prices, while Trump’s healthcare policy points to a more free-market solution. He suggests that allowing US citizens access to less expensive imported medicines will reduce prescription prices.
Benchmarking Paul Ryan
President Trump will likely depend on Washington operatives like Paul Ryan to “put the meat on the bones” of his health-care reform plans. The 2013 version of Mr. Ryan’s “Path to Prosperity” publication covers great changes to healthcare and social services. Considering this, Paul Ryan is to healthcare as acetone is to nail polish. His proposals would dissolve many of the current structures. He proposes privatizing Medicare, removing roughly 44 million people from Medicaid, as well as “…40 percent cuts in transportation and education spending, and 24 percent cuts to veterans’ programs, among others” according to the Kaiser Family Foundation.
Repeal and replace Obamacare
“Repeal and replace” Obamacare is certainly at the top of President-elect Trump’s agenda, and given that Congress made 36 separate attempts to derail or remove funding for the Affordable Care Act (ACA), it’s likely that one of the old bills will be dusted off and promptly sent to Pres. Trump after his inauguration. Without funding, certain of the essential elements of ACA, such as premium subsidies, it will surely dissolve its appeal. The requirement that employers offer and that employees obtain health insurance (the “mandate”) is also likely doomed. Like a Jenga puzzle tower, with a few key pieces removed, ACA could collapse.
Significant uncertainty remains, however, and based on the campaign and election so far, we can be sure that a few more surprises are in store.