What Can We Expect from a Trump Presidency?

A week after the presidential election, many Americans are wondering what a Trump presidency means for them.  More specifically, what does it mean for their health insurance? Three days after the election, more than 300,000 people have selected plans from the Exchanges.  The Exchange is the online marketplace where consumers can compare and buy individual health insurance plans.  However, an increase in premiums coupled with a Republican majority House, Senate, and White House places the Affordable Care Act (ACA) in jeopardy.  On the campaign trail, President-Elect Trump has called the ACA “unworkable.” However, in recent interviews, he has favored continued coverage for children on their parents’ insurance policies and prohibits discrimination for those with pre-existing conditions.

Dismantling the ACA
There are a few ways Republicans could dismantle the ACA.  First, Republicans can repeal the Act in its entirety.  This method of dismantling the ACA would require a 60-vote majority in the Senate. Further, this method is subjected to filibusters by Democrats, thus delaying voting.  As a general matter, this method seems highly unlikely given the Republicans hold 54 seats in the Senate.” The second way Republicans could dismantle the ACA is through a method called budget reconciliation.  Budget reconciliation would create revenue related challenges for the implementation of ACA.  For example through the budget reconciliation process, Republicans could remove premium tax credits for consumers. This method only needs a simple majority and does not have a filibuster option.  Budget reconciliation has a greater likelihood of undoing parts of the ACA.  However, this process would take at least two years for substantial change to affect consumers.

The New Plan
This leads to our next question, what do we replace the ACA with? President-Elect Trump hasn’t provided the public with substantial policy changes, however we can look towards the Republican’s plan entitled, A Better Way, to identify what may happen. There are three changes we can reasonably anticipate.  First, we can reasonably anticipate changes in Medicaid. Due to Medicaid expansion, the federal government covers about 90% of the costs related to covering childless adults.  A Better Way promulgates shifting to block grants for the states. This invariably means that states would receive lower funds and therefore may have to reduce coverage and may adopt plans similar to those seen in Indiana. In Indiana, Medicaid participants are required to pay into accounts in order to benefit from Medicaid. The amount could be as low as a dollar, but participants must pay into the program.  Additionally, it requires participants to pay copays, which can cost up to $25. These measures support the concept of individual responsibility.

The second substantial change we can anticipate is a decrease in coverage options. Currently, essential benefits require plans to offer specific coverage such as, maternity care, birth control, preventive screenings, and mental health. Republicans will most likely remove or decrease what some considered an essential benefit. This of course is in an effort to make coverage more affordable, but at the determinant of quality.  The third substantial change we can anticipate is the use of high risk pool plans. High risk pool plans cover individuals who have been locked out of the market by pre-existing conditions. However, traditionally, the premiums for those in high risk pool plans were twice high as those individuals who are healthy.

Although we are unclear about what will happen on January 20^th, we can anticipate substantive changes. Republicans promulgate to make changes on day one of Trump’s Presidency and Democrats will have to act in defiance or work with the Trump administration to salvage parts of the ACA.