Who Will This Affect
The poor, the sick, older Americans, women and possibly small business owners will all be affected by Trumps moves, according to doctors. About 12.7 million people rely on health insurance marketplaces created by Obamacare.
A joint statement from six physicians groups said Trumps executive order on low-cost plans would probably cause significant economic harm to women and older, sicker Americans who stand to face higher-cost and fewer insurance options.
Democrats said the actions could cause serious, structural damage to American healthcare. Democratic congressional leaders Senator Chuck Schumer and Representative Nancy Pelosi called his actions a, spiteful act of vast, pointless sabotage, in a joint statement.
And the Republican senator Susan Collins, whose vote helped doom Republican repeal plans, said she was very concerned that Trump had ended an important subsidy that helps very low income people.
Tax Relief For The Middle Class
Passed $3.2 trillion in historic tax relief and reformed the tax code.
- Signed the Tax Cuts and Jobs Act the largest tax reform package in history.
- More than 6 million American workers received wage increases, bonuses, and increased benefits thanks to the tax cuts.
- A typical family of four earning $75,000 received an income tax cut of more than $2,000 slashing their tax bill in half.
- Doubled the standard deduction making the first $24,000 earned by a married couple completely tax-free.
- Doubled the child tax credit.
- Virtually eliminated the unfair Estate Tax, or Death Tax.
- Cut the business tax rate from 35 percent the highest in the developed world all the way down to 21 percent.
- Small businesses can now deduct 20 percent of their business income.
- Businesses can now deduct 100 percent of the cost of their capital investments in the year the investment is made.
- Since the passage of tax cuts, the share of total wealth held by the bottom half of households has increased, while the share held by the top 1 percent has decreased.
- Over 400 companies have announced bonuses, wage increases, new hires, or new investments in the United States.
- Over $1.5 trillion was repatriated into the United States from overseas.
- Lower investment cost and higher capital returns led to faster growth in the middle class, real wages, and international competitiveness.
Jobs and investments are pouring into Opportunity Zones.
Vice President Mike Pence
Pence on healthcare
- The Trump campaign released a statement on November 14, 2016, detailing what Pence discussed at the Republican Governors Association Annual Conference. At the event, Pence “reiterated…Trumps strong commitment to repeal and replace Obamacare and block grant Medicaid funding to state governments to encourage innovation that better delivers healthcare to eligible residents.”
Pence on the AHCA
- On June 3, 2017, Pence urged members of Congress to pass the American Health Care Act of 2017 during a political rally in Iowa. He said, “First and foremost, this summer, this Congress must come together and heed the president’s leadership, and we must repeal and replace Obamacare. … Once we repeal and replace Obamacare, we’re going to roll our sleeves up, and working with these great leaders in Congress, we’re going to pass one of the largest tax cuts in American history.”
- On May 4, 2017, after the House passed the AHCA, Pence said, “It was March, 2010, seven years ago, Democrats passed a government takeover of healthcare. And at that time, Republicans in Congress promised the American people that law would not stand. Today, thanks to the perseverance, the determination, and the leadership of President Donald Trump, and all the support of those gathered here, weve taken a historic first step to repeal and replace Obamacare and finally give the American people the kind of healthcare they deserve.”
Pence on the ACA
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Funds To Facilitate Healthcaregov Sign
What is it? The ACA created Navigator programs and an advertising budget to help people figure out specifics of the new federally run insurance exchanges and sign up for coverage.
What changed? In August 2017, the administration significantly cut federal funding for these programs.
What does the administration say? “It’s time for the Navigator program to evolve. … This decision reflects CMS’ commitment to put federal dollars for the federally facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process.” CMS Administrator Seema Verma,
What’s the impact? It’s hard to document what the impact of this particular cut was on enrollment. The cuts were uneven, and some states and cities got creative to keep providing services. “We have seen erosion in overall health insurance coverage,” Corlette says. “But it’s hard to know whether that’s the effect of the individual mandate going away, the short-term plans or the reductions in marketing and outreach it’s really hard to tease out the impact of those three changes.”
Abbe Gluck, director of the Solomon Center for Health Law and Policy at Yale, cautions that though the law has proven to be stronger than expected, all these actions by the Trump administration have, indeed, had an effect.
Despite that, one of the things that has kept the marketplaces as strong as they are, Gluck notes, is that they’re not all run by the federal government.
Trump Administration Asks Supreme Court To Strike Down Affordable Care Act
If successful, the move would permanently end the health insurance program popularly known as Obamacare and wipe out coverage for as many as 23 million Americans.
WASHINGTON The Trump administration asked the Supreme Court late Thursday to overturn the Affordable Care Act a move that, if successful, would bring a permanent end to the health insurance program popularly known as Obamacare and wipe out coverage for as many as 23 million Americans.
In an 82-page brief submitted an hour before a midnight deadline, the administration joined Republican officials in Texas and 17 other states in arguing that in 2017, Congress, then controlled by Republicans, had rendered the law unconstitutional when it zeroed out the tax penalty for not buying insurance the so-called individual mandate.
The administrations argument, coming in the thick of an election season as well as a pandemic that has devastated the economy and left millions of unemployed Americans without health coverage is sure to reignite Washingtons bitter political debate over health care.
In his brief, Solicitor General Noel J. Francisco argued that the health laws two remaining central provisions are now invalid because Congress intended that all three work together.
The court has not said when it will hear oral arguments, but they are most likely to take place in the fall, just as Americans are preparing to go to the polls in November.
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What A Bipartisan Health Care Agenda Could Actually Look Like In A Second Trump Term
Theres actually quite a long list of areas in which both Democrats and Republicans want to act on health care, based on my conversations.
Everybody wants to reduce prescription drug prices, and Trump has often sounded more like a Democrat than a Republican on that issue, favoring aggressive intervention by the federal government. Surprise medical bills remain the source of cross-party outrage, and there was movement late last year toward a bipartisan fix, which came up short but could be revived.
I think if Trump is reelected on drug pricing, there will be another push for legislative reform, Monk said. There actually is a lot of common ground. … I dont see Trump totally cruising on that issue.
There are also new issues that have cropped up during the coronavirus pandemic and require longer-term solutions and likely congressional action. The Trump administration has made regulatory changes to better compensate telehealth visits for doctors, but those would lapse unless they are written into federal statute. The supply chain issues that have contributed to shortages of personal protective equipment and testing supplies could also be addressed through Congress, and there could be bipartisan interest in preventing the problems of the last few months from repeating themselves in a similar crisis.
The Trump presidency has been nothing if not unpredictable. The Supreme Court could ensure that applies to the next four years of health care policy as well.
New goal: 25,000
Accurate And Impartial Information
Jessica Altman, insurance commissioner for Pennsylvania, which launched a state-based exchange this year after using Healthcare.gov since 2014, said she was certain her state would not choose the direct enrollment option.
One of the core values of the ACA is making sure people are given the opportunity to truly shop and see all the plans with fair, accurate and impartial information, she said, which would not be the case with direct enrollment entities.
Unlike the navigators, Altman said, brokers would have an incentive to push consumers toward policies that offer the greatest commissions.
She is particularly concerned that brokers seeking high commissions would point consumers to short-term plans, which usually dont offer the comprehensive coverage of ACA-compliant plans, such as protections for pre-existing conditions. Such plans, which the Trump administration made legal, often leave patients with huge bills for services.
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Ways The Trump Administration Is Changing Healthcare
While a full repeal of the Affordable Care Act in Congress failed last year, the Trump administration, in the courts and through regulation, has managed to get closer and closer to its goal as a matter of practicality. As health policy watchers wait for an impending decision to drop in Texas v Azar, the case about the constitutionality of the ACA, here is a look back at the healthcare actions taken during the first 2 years of the Trump administration.
When Donald Trump became president, he did so after campaigning on specific ways he intended to shake up healthcare, starting with a repeal of the Affordable Care Act . While a full repeal in Congress failed last year, the administration, in the courts and through regulation, has managed to get closer and closer to its goal as a matter of practicality.
As health policy watchers wait for an impending decision to drop in Texas v Azar, the case about the constitutionality of the ACA, which the Department of Justice decided not to defend, here is a look back at the healthcare actions taken during the first 2 years of the Trump administration.
1. Chipping away at protections for pre-existing conditions
But if the judge rules against the ACA, Democrats, who will retake the House of Representatives in January, have pledged to protect the law. A showdown in the Supreme Court, with newly appointed Justice Brett Kavanaugh, is also likely.
2. Promoting and treating STLDHPs and AHPs like ACA-type health insurance
What The Data Reveals
Dr. Andrew Bindman, a professor of medicine, epidemiology, and biostatistics and a core faculty member at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, told Healthline that the Trump administration has made it an explicit goal from day one to undermine the ACA.
While President Trump failed to deliver on his promise to overturn the ACA, he has done all he could without the approval of Congress to sabotage the law, Bindman said.
Unlike President Obama, who focused on expanded coverage, President Trumps legacy is a decline in healthcare coverage, leaving Americans less protected during a pandemic when the security of healthcare coverage is more important than ever, he said.
Bindman knows a lot about the ACA since he was one of the people who helped draft it. He made his contributions to the legislation when he served as a health policy fellow on the staff of the House Energy and Commerce Committee.
Like Bindman, John McDonough, DrPH, MPA, a professor of public health practice in the department of health policy and management at the Harvard T.H. Chan School of Public Health and director of executive and continuing professional education, is another person intimately familiar with the healthcare plan.
He worked on the development and passage of the ACA while a senior adviser on national health reform to the Senate Committee on Health, Education, Labor, and Pensions.
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Why States Worry That ‘association Health Plans’ Will Be Magnets For Scam Artists
‘Association health plans’ were once riddled with fraud and insolvency. Now the Trump administration wants to bring them back.
Medicaid-eligible people are likely to be especially susceptible to that pressure, Altman said.
There will be a lot of opportunities and perhaps pitfalls for consumers to be directed to plans that dont meet QHP-certified standards, said Christina Cousart, a senior policy associate at the National Academy for State Health Policy.
But Ed Haislmaier, a health policy researcher at the conservative Heritage Foundation, said that in a few scattered cases around the country, insurance carriers with ACA-compliant policies did not join the exchanges. Direct enrollment would make it easier for consumers to purchase policies from those companies, he said.
Overall, he said he thought the effects of the proposed rule would be pretty marginal.
Others disagree. I think the advantage of an exchange is that it offers apples to apples shopping comparison experience, said Johanna Fabian-Marks, director of policy and plan management of the Maryland Health Benefit Exchange.
Its important to have detailed information impartially offered on all plans offered. When you lose that hub approach it can make it potentially more confusing for consumers to navigate and compare the options.
She said Maryland would not be interested in a direct enrollment option.
Will Trump Be Blamed If People Lose Health Coverage
The president is sure he wont. Were not going to own it, he said in July. Im not going to own it. I can tell you the Republicans are not going to own it. Earlier this week he told Forbes: Ive always said Obamacare is Obamas fault. Its never going to be our fault.
The public seems to disagree. A recent poll showed 60% think Trump and the Republicans, not Obama and the Democrats, are responsible for the ACAs success or failure.
Trump will try to blame the ACA, but this will fall on his back and he will pay the price for it, Schumer and Pelosi predicted in their joint statement.
Trump himself seemed to imply his moves which are likely to face legal challenge may have been brinksmanship intended to force Democrats to the table. The Democrats ObamaCare is imploding, he wrote on Twitter. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!
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Insurance Company Profits Have Soared While Families Pay More
Across all lines of business, insurance companiesprofit margin has increased in recent years, shooting up from about 1 percent in 2016 to 3 percent in 2019. Insurance company profits have been boosted by a number of factors, including the expansion of companies business in Medicare Advantage and Medicaid and the benefits of relatively unchecked vertical consolidation with other firms in the health care industry. In years to come, insurance companies stand to benefit if Trump follows through on his executive order to shift more Medicare beneficiaries into private plans, to the detriment of beneficiaries access to providers.
Figure 2
While the pandemic has depressed economic activity this year in most industries, insurance companies profitability to date has topped last years. Medical spending is down dramatically in 2020 due to deferred care during the pandemic, boosting companies net income above expectations. Thanks to the ACAs medical loss ratio requirement, insurers will be required to return excess premiums to consumers if medical spending for the year is below what they anticipated. Meanwhile, the federal Centers for Medicare & Medicaid Services and state regulators have encouraged or required insurers to waive or discount premiums and cost sharing in order to assist consumers and meet medical loss requirements.
