Healthcare Reform in the Trump Administration
Now that the proverbial dust has settled after a very contentious and controversial 2016 presidential campaign, citizens of the United States are likely to experience drastic healthcare reform over the next several years. Donald Trump has repeatedly expressed his intention to repeal and replace the Affordable Care Act (ACA), also known as Obamacare, in order to make healthcare more affordable for all Americans. In this article, I will delineate Trump’s overarching objectives in reforming the healthcare sector and their ethical consequences.
Republicans have been trying to repeal the ACA since it was passed in 2010, but now they have the power to do so since they possess the majority in both houses of Congress and the presidency. However, if President-elect Trump directly repeals the law, he will likely face retaliation in the form of a Democratic filibuster2. Therefore, it is possible he will enact change through several more subtle mechanisms. One method he could employ would be to simply not enforce the individual mandate that requires most people to have insurance. Mandating that healthy people sign up for health insurance spreads the costs of people with high bills over a larger population3. Therefore, removing the mandate would cause sick people to pay even more for their insurance, which could incentivize those that are sick to not buy insurance altogether. Another manner through which President-elect Trump could severely derail the ACA is to drop the Obama administration’s appeal of the lawsuit House v. Burwell, which Republicans filed in 2014. The suit claims that the Obama administration is unconstitutionally spending money to reimburse health insurers who were providing coverage to those at or near the poverty line3. More than half of the people who purchase insurance under the ACA also receive this coverage that was subsidized indirectly by the Obama administration. The ACA requires that insurers provide healthcare coverage, but it does not specify where the funding for this coverage would originate. If president-elect Trump drops the Obama administration’s appeal, then funding for health coverage could not come from the government, even though insurers would still be required to provide the insurance. The question then arises, from where would the funding for that insurance originate? If no clear answer becomes apparent, then insurers would simply drop out of the health exchanges program. Such an event could lead to the eventual degradation of the Affordable Care Act.
Donald Trump has presented several ideas on what he believes should replace Obamacare, following a theme of deregulating the healthcare sector in order to promote more competition and lower costs. To that effect, there are several programs provided by the ACA that President-elect Trump has expressed an interest in keeping. These include allowing young adults to remain on their parents’ health insurance policy until the age of 26 and requiring firms to sell insurance to anyone, regardless of any pre-existing condition2. Additionally, he wants to make healthcare premiums tax-deductible, allow health insurance to be sold across state lines, and change the way the federal government funds Medicaid programs4. One way that Trump has proposed for people to receive affordable health insurance beyond Obamacare exchanges is through the promotion of Health Savings Accounts (HSA). These accounts are analogous to a normal savings accounts, except that people spend their savings on health insurance and receive tax breaks for maintaining a HSA. Essentially, Trump wants to incentivize people to buy health insurance rather than mandating them to do so in order to provide a more affordable coverage alternative for Americans.
President-elect Trump has not given a clear process nor plan to reaching these goals while simultaneously repealing the portions of the Affordable Care Act that make the policy a “disaster”3. Depending on how aggressive President-elect Trump becomes in his health policy approach, twenty million Americans could be left without insurance4.
An interesting subtopic in this discussion is how healthcare in California will be affected under a Trump administration. Of the twenty million people in America that have health insurance as a result of Obamacare, twenty five percent live in California1. California recently expanded its Medicaid program so that more individuals could qualify for care; changing the program could cause all those recently insured people to once again lack coverage. As stated previously, Donald Trump has described changing the way that Medicaid is funded in order to cut down on costs. Currently, government funding for Medicaid is a function of how many people are covered, without a limit on the number of people enrolled for the program. This implies that the federal government allocates a lot of money to states that have a lot of people on Medicaid – like California – and a smaller amount of money to states without a lot of Medicaid-participants. President-elect Trump wants to cap federal funding for Medicaid at a certain fixed amount for each state1. Enacting this policy would leave California with less money to fund Medicaid, leaving the state with two options: either pay hospitals and doctors less money, or reduce the services and/or the number of people who qualify for Medicaid. For California, the former is not a likely option because the state already pays doctors and hospitals the second-lowest rate in the nation1. Consequently, it is very possible that millions of people in California will be left without insurance after just recently becoming covered.
The United States is currently in the midst of a very tumultuous and uncertain epoch in its history, partly due to apprehension about how the president-elect’s stance on issues such as healthcare reform, immigration, and foreign policy develop and manifest over the next several months.
1. Dembowsky April, “What happens to Medi-Cal under a Trump Administration?,” KQED News: the California Report, Nov 11, 2016, Accessed Nov 29, 2016. https://ww2.kqed.org/news/2016/11/11/what-happens-to-medi-cal-under-a-trump-administration/.
2. Kodjak Allison, “Trump can kill Obamacare with or without help from Congress,” National Public Radio, Nov 9, 2016, Accessed Nov 29, 2016. http://www.npr.org/sections/health-shots/2016/11/09/501203831/trump-can-kill-obamacare-with-or-without-help-from-congress.
3. Rovner Julie, “How a President Trump could derail Obamacare by dropping legal appeal,” National Public Radio, Nov 9 2016, Accessed Nov 29 2016. http://www.npr.org/sections/health-shots/2016/11/09/501421924/how-president-trump-could-derail-obamacare-by-dropping-legal-appeal.
4. Shryock Todd, “How will the Trump administration change Healthcare?,” Medical Economics, Nov 9, 2016, Accessed Nov 29, 2016. http://medicaleconomics.modernmedicine.com/medical-economics/news/how-will-trump-administration-change-healthcare?page=0,0.