How might health insurance change under the incoming administration? originally appeared on Quora - the knowledge sharing network where compelling questions are answered by people with unique insights.
Answer by Jennifer Fitzgerald, CEO and Co-Founder of PolicyGenius, on Quora.
How might health insurance change under the incoming administration? The short, unsatisfying answer is that no one knows at this point. That's mostly because as a candidate, Trump didn't offer many specifics on his healthcare platform while he was on the campaign trail. (You may have seen the news over the weekend that healthcare is not, in fact, listed on The White House as a top issue but that President Trump has signed an executive order to begin dismantling the ACA.) What we have to go on are the number of other GOP plans that he's endorsed in some way or another. They give us a hint at what health insurance will look like under the new administration.
Part of the challenge with repealing health insurance as it exists under Obamacare is that, as much attention as skyrocketing premiums got over the past year, the plan itself is still relatively well-liked. Recent polls show that its popularity has grown over the last couple of weeks, especially features disallowing discrimination against pre-existing conditions and letting people stay on their parents' insurance until they turn 26. There's also the fact that the individual mandate powers much of the law, and removing that will have a ripple effect on other aspects of the new healthcare policy.
Medicare and Medicaid are up for reform with nearly every Republican. How, exactly, remains to be seen (a common refrain on this topic) but Paul Ryan, for example, wants to require premium payments for Medicare support. In terms of health insurance, this would complicate the way that many seniors receive their health insurance. As for Medicaid, it's more than likely that we'll see the program move to a block grant system, where instead of states getting matching dollars from the federal government, they just get a lump sum of money. The Center on Budget and Policy Priorities predicts that Medicaid and CHIP (Children's Health Insurance Program) would be cut by more than 26% by 2024. Nearly 16 million people have enrolled in Medicaid and CHIP since their expansion in 2013 as part of the ACA, so slashing that funding would leave a lot of people to find alternate means of paying for health insurance.
So if Republicans decide to repeal Obamacare, what's next? It depends on which of the GOP plans floating around are chosen. President Trump's pick for the head of Health and Human Services, Tom Price, devised the Empowering Patients First Act in 2015, which is one of the frontrunners. It would repeal the Obamacare Medicaid expansion, provide purchasing assistance based on age rather than income, and has a continuous coverage provision (where insurers could discriminate against pre-existing conditions only if a consumer has a lapse in coverage). The other main replacement plan comes from Paul Ryan. Ryan wants to remove the Obamacare premium support subsidies with refundable tax credit, which has some people questioning how that will actually be different. Ryan's plan also advocates selling insurance across state lines and revamping Medicaid.
Bill Cassidy and Susan Collins' plan would let people choose between keeping their Obamacare coverage, forgo coverage, or move to a new system where they're automatically enrolled in a plan that's supplemented by health savings accounts.
Lamar Alexander has a plan that will "adjust Obamacare's special enrollment periods" and let the 10 essential health benefits, currently included in every plan, to be more "flexible" and determined on a state-by-state basis.
So, we have to take a wait-and-see approach to what the new administration will do, but there are a few constants around what they could do. The other question will be when any of these plans will be put into place - whether "repeal and delay" or "repeal and replace" will win out.
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