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.
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.
I’m a pundit who like everyone else was surprised by Trump’s victory in the (profoundly undemocratic and hopefully-to-be-abolished-soon) electoral college, and everything I say here is prefaced by the fact that there was very little discussion of healthcare specifics by Trump. So there’s no certainty about what will happen–to state the obvious about his administration!
