BY KEN TERRY

Donald Trump—along with some Republican leaders—says he wants to keep certain parts of Obamacare, such as letting young adults stay on their parents’ plans through age 26 and banning pre-existing condition exclusions. Coupled with the plan that Trump recently unveiled on his website—a grab-bag of hoary Republican talking points–these comments show how little Trump knows about health care.

Take the pre-existing exclusion ban, for example. As New York State proved years ago, requiring the guaranteed issue of coverage without a mandate to buy it makes individual health insurance unaffordable. Insurers must raise their rates if not enough healthy people buy their product or if people can wait until they become acutely ill before they seek coverage.

Selling insurance across state lines is another Republican replacement for rational thought. If people are allowed to shop for insurance across state lines, insurance companies will set up plans in the state that regulates insurance the least—say, Mississippi. Then they’ll sell cheap, skimpy plans across the country. Unfortunately, their customers will discover that those plans cover very little when they get sick.

In addition, the plans that are selling coverage in Mississippi would need to create provider networks all across the country. That would be a gargantuan task, and the insurers would likely build the same kind of narrow networks that Obamacare has been criticized for. The net result: crappy coverage and little choice.

The piece de resistance of the Trumpian healthcare plan is more consumer-directed plans with health savings accounts (HSAs) and high deductibles. HSAs are tax-favored accounts that can be rolled over from year to year and can be used to pay for medical expenses. They may be funded jointly by employers and employees or solely by individuals. These consumer-directed plans have expanded under Obama, and Trump wants to encourage them to grow further.

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BY JAAN SIDOROV

While readers digest the reality of a Trump Presidency and Republican control of both houses of Congress, your correspondent has been trying to assess the “down ballot” implications for healthcare and mHealth providers.

While the universe has been turned upside down, its initial reaction for mHealth is bullish. As for the rest……. read on.

While he was a wacky campaigner, your correspondent suspects that Mr. Trump’s “campaign promises” were really opening negotiating positions. While immigration, the Supreme Court and business regulatory reform will be top of mind, he’ll eventually get around to making deals in the healthcare space, because that is his nature. That is the real wild card and increases uncertainty.

That being said, what can your correspondent predict?

Given Mr. Trump’s and the Republican majority antipathy to Obamacare, the Affordable Care Act is likely to be gutted. While U.S. Senate Democrats can create mischief with the filibuster, many are also up for election in two years. As a result, commercial insurance premium subsidies, the minimum benefit, the IRS penalty and ACOs are toast.

Because it’s working pretty well, your humble correspondent rates it as unlikely that Congress will alter the basic underpinnings of fee-for-service Medicare and the Medicare Advantage programs. Unfortunately, however, that also means that the complex reporting and payment changes of MACRA – and its premise of “value-driven” Medicare – will stay on track.

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By PAUL KECKLEY

The new Chief Executive Officer of the United States of America Inc. will take office January 20th and likely make good on his promise to repeal the Patient Protection and Affordable Care Act. It only requires a majority in both houses of Congress to pass and that’s assured based on the election results last week.

• Immediately, the focus will shift to its replacement which is certain to be more complicated. Speculation about how his healthcare team will craft its own version of health reform 2.0 is at fever pitch. Questions are swirling about pieces of the law that might be carried over and those that might get the ax….
• Will the Trump C suite align its replacement policy with Speaker Ryan’s “Better Way” though the positions of the two seem somewhat at odds, especially around reforms to Medicare including its transition to a premium support plan that encourages seniors to purchase coverage from private insurers with subsidies up to $8000 per senior?
• What’s to become of the ACA’s insurance mandates for employers and individuals? Do they go away?
• Will excise taxes paid by insurers, medical device manufacturers and increased personal income taxes paid by U.S. federal taxpayers be refunded since they were included in the ACA as a means of funding the trillion-dollar program?
• How will President Trump deliver on promises to make healthcare affordable while keeping the ACA’s guaranteed issue restrictions on insurers?
• How will Medicaid expansion be a funded in the 31 states that chose to accept the federal deal in the ACA, and what’s it mean for the 19 states that didn’t?
• What becomes of alternative payment programs like accountable care organizations, bundled payments, value-based purchasing and others that have consumed a considerable time and attention by provider organizations?
• And as the fourth marketplace enrollment period nears ends in January, what’s to become of the tax subsidies for the 12 million expected to enroll?
• And beyond the ACA’s repeal, speculation about appointments to the Supreme Court and key healthcare agencies, strategies to allow importation of prescription drugs, how the Justice Department will weigh in on industry consolidation, private inurement and many other issues is running high as the team Trump’s health policy agenda takes shape.

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By GARY MENDOZA

Friday, Healthcare IT News reported that most healthcare executives “express a dystopian view of a Trump presidency’s impact on healthcare”.

While significant changes to the ACA and beyond are coming, the sky won’t be falling any time soon.

Political reality, market and fiscal pressures and President-elect Trump’s statements before his election and since make that clear.

Here’s what lies ahead.

What will change.  Trump’s election will accelerate the ACA’s demise. 

His victory won’t be its cause.  

The ACA’s combination of a weak individual mandate, broad mandated benefits and guaranteed issue hard-wired that outcome.

The individual mandate is the ACA’s least popular provision.  That’s why the Obama Administration weakened it during implementation.  It’s certain to go.

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By MARGALIT GUR-ARIE

The American people, myself proudly included, chose to send you to Washington DC to do their bidding. That’s what happened on November 8^th 2016. Everything you hear now from the elite punditry is aimed at obfuscating this simple truth. Forget about dainty glass ceilings, we the people were able to break through the fortified ramparts erected by entrenched money and power and exercise our right to govern ourselves. I would caution the smug intelligentsia against underestimating the wisdom of the people once again, and I would caution you against forgetting who sent you there and why we did so. We now know we have the power, and what the people giveth, the people can taketh away.

RYANCARE

The ecstatic welcome you received from Paul Ryan and Mitch McConnell the other day looks more like an act of violence than one of true reconciliation. Fair weather friends are usually there because they want something, and in this case they want to highjack the people’s agenda and replace it with their own conservative garbage. Mr. Ryan in particular has been proposing bogus alternatives to Obamacare with alarming regularity. Similar to Obamacare, Mr. Ryan’s health reform plan is based on belief in his own superior intelligence and devoid of any evidence that it can indeed work. Unlike Obamacare, the Ryan plan is also based on the assumption that helping the poor get poorer and the rich get richer is the ultimate role of government.

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By ROBERT LASZEWSKI

The Wall Street Journal, The Washington Post, CBS News and other news outlets have led with headlines over the weekend touting the big news that Donald Trump is willing to keep parts of the Affordable Care Act––notably the pre-existing condition protections and the ability for children up to the age of 26 to stay on their parents policies.

Except this isn’t news.

In May, Trump’s policy advisor told Healthline that a Trump administration would consider keeping the children to age 26 provision.

And, then there is this February debate exchange between Trump and a CNN moderator:

TRUMP: “I want to keep pre-existing conditions [the Obamacare provision that prohibits insurers from denying coverage]. I think we need it. I think it’s a modern age. And I think we have to have it.”

DANA BASH: “Okay, so let’s talk about pre-existing conditions. What the insurance companies say is that the only way that they can cover people is to have a mandate requiring everybody purchase health insurance. Are they wrong?”

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