Following Donald Trump’s presidential victory, many Americans are wondering what his win means for healthcare. Industry people—physicians, hospital CEOs, insurers, pharmaceutical manufacturers—are obviously paying very close attention, but so are consumers.
Healthcare touches everyone, and almost every American will be affected by what happens next.
Right now, it is difficult to say with certainty what’s around the corner for the healthcare industry. But in looking at Trump’s campaign platforms, previous Republican efforts and consumer desires, we can make a few predictions.
Here’s what one can reasonably expect in 2017.
Trump has said he will repeal the Affordable Care Act, and we ought to take him at his word. Republicans have been fighting for the repeal of President Obama’s signature health law since it was implemented. Now that they control the House, Senate and presidency, there is a clearer path than ever before.
Just this January, Congress successfully passed a bill defunding the law, using a budget reconciliation process, which bypasses filibuster efforts from opponents. Of course, Obama vetoed it, but the outcome under President Trump will likely be very different.
Even so, some experts say that Republicans have been so staunchly opposed to the ACA not in spite of their inability to repeal it, but directly because a repeal was so unlikely. Opposing the law won points with their constituents, and the chance of actually cutting coverage was slim. Now, with 22 million people poised to lose their insurance, some experts say Republicans could waver in their position.
Trump also began walking back some of his total-repeal claims very soon after his election. He has said he likes the more popular pieces of the law, like allowing dependents to stay on their parent’s plan until age 26, and continuing to prohibit insurers from denying coverage to people with pre-existing conditions.
But arguably, Republicans will repeal Obamacare. They have been attempting to do so for many years, and if they don’t, any bad press or public dissatisfaction with healthcare will fall squarely on their shoulders. As a party, they haven’t put forth distinct legislation as a replacement, but there are a few elements we can expect.
This is another key tenet of conservative health policy. Block-granted Medicaid means doing away with federal requirements that currently tie funding to certain levels of coverage. Instead, states could receive a lump sum of Medicaid dollars, probably based on the number of people to be covered, and individual states can structure their plans as they please.
Proponents of this plan say it gives states more autonomy in administering the program, allowing them to serve their low-income populations best. Opponents say it leads to gutted programs and fewer benefits for the poor.
Trump has promised to block-grant Medicaid, and as with the ACA, if Republicans aren’t able to do it in 2017, they will have no one to blame. Yet, this might be harder than Trump realizes. Plans to block-grant the program have been unsuccessfully put forth by Presidents Ronald Reagan and George W. Bush, as well as former House Speaker Newt Gingrich.
Return to pre-ACA insurance market
A repeal of the ACA would mean the end of the marketplaces, and likely a return to the pre-Obamacare individual market. The majority of Americans have workplace coverage, and this won’t be particularly disruptive to them, nor those who have Medicare or Medicaid. But for the seven percent of people who bought coverage through the exchanges, this will be significant.
Particularly, those with pre-existing conditions could be very vulnerable unless Trump continues to disallow coverage denials. Healthy consumers without workplace coverage have almost always been able to find insurance on the individual market. But those with pre-existing conditions and no group options have often had to remain uninsured.
If insurers still must cover consumers with pre-existing conditions, but Trump repeals the individual mandate, younger, healthier people will probably abandon the health insurance market, as they did before the ACA. This will only lead to sicker populations for insurers, and higher prices as a consequence.
Before the ACA, several states had high-risk pools, which were essentially a government-subsidized health plan option for those with pre-existing conditions. Trump has not said whether he plans to evaluate high-risk pools or other alternatives for these consumers.
He has said that he will improve competition by allowing insurers to sell across state lines. This is also a common conservative policy, but there is little evidence that it is particularly useful in driving competition. Because health plans are built around networks of medical providers, and if a carrier doesn’t have competitive contracts with providers in your city, they are unlikely to be able to offer you a competitive product.
For consumers living near state lines, being able to buy a plan in a nearby market might increase their options, but that isn’t guaranteed. Between 2008 and 2011, six states enacted this type of legislation and not one of the states saw a single insurer enter a new market or offer a new product.
Ultimately, there are still a lot of unknowns when it comes to healthcare under President Trump. Any legislative action will likely take some time to enact and implement, which means marketplace consumers will probably not see much change next year. But there are just nine short months between Trump’s inauguration and what would be the fifth open enrollment.
What happens between now and then could affect healthcare for all Americans for the foreseeable future.