Less Coverage And Higher Costs: The Trumps Administrations Health Care Legacy
During his 2016 campaign, President Donald Trump repeatedly said he was for insurance for everybody and promised to take care of everybody and to lower costs. Almost four years later, the Trump administrations record falls far short of these promises: The number of uninsured Americans has swelled, his administration has chipped away at the consumer protections guaranteed by the Affordable Care Act , costs have risen for Americans with marketplace plans, and the nation is mired in a public health crisis.
The wake of one of the administrations most destructive health care policies may trail far beyond this term of his presidency. The health care repeal lawsuit that he helped advance to the U.S. Supreme Court could invalidate the entire ACA next spring, ending coverage for more than 20 million Americans, driving up costs for those seeking to buy coverage on their own, and eliminating consumer protections for millions of people with preexisting conditionsall in the midst of the COVID-19 pandemic.
How Does It Compare To Biden’s Healthcare Plan
If Biden wins, there will be a different, and seemingly bolder set of priorities for reshaping the ACA.
The possibility of a public option is one of the biggest differences between his plan and Trump’s.
The Biden campaign also says it will eliminate the cap on ACA insurance subsidies, so that people making more than 400% of the federal poverty level qualify for tax credits.
“You’re going to see a big push in trying to make it more affordable,” Emanuel said.
Another campaign promise from the Biden team: lowering the cap on how much coverage in the ACA marketplace can cost, from 9.86% of a person’s income to 8.5%.
Regardless of who wins the election, it’s going to take a lot longer than four more years for this healthcare law to mature.
Just look at how many times Social Security’s been reformed and tweaked, since it was enacted by President Roosevelt in 1935. Or the changes that have been brought to the Medicare and Medicaid systems, since they were signed into law by President Johnson in 1965.
President Obama’s Affordable Care Act has joined this cannon of sweeping reforms. As such, it will take decades to refine, through many more presidents, and many more sessions of Congress. Despite what you might’ve heard about “repeal” or “replace,” improving it will take more continuous, measured improvement of the system than any one President alone can provide.
Trumpcare Has Been Met With Political Resistance
Trumpcare was scheduled to be voted on by the House in March of 2017, but the bill was pulled at the last minute due to Republican fears that it would not get enough votes to pass.
After making some changes to the bill, it was brought before the House in early May of 2017, and it passed by a count of 217-213, with 20 Republicans voting against it. No Democrats voted for the bill.
The Senate declined to vote on the bill as it was and instead formed the aforementioned panel to make changes.
Trumpcare has also received opposition from a number of organizations including AARP, the American Medical Association, the American Nurses Association, the American Academy of Pediatrics and the American Hospital Association, among others.
Opposition of Trumpcare was spurred in part by a report released by the non-partisan Congressional Budget Office , which estimated that the number of uninsured people under the age of 65 would nearly double by 2026.2
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Obamacare Taxes Still In Effect
Even though the mandate no longer applies, there are still some taxes related to Obamacare:
- If you make more than $200,000 a year: Taxes increased in 2013 for individuals making more than $200,000 a year or $250,000 for married couples, some health care providers, and other health-related businesses.
- If you’re a business owner: If you have 50 or more employees, you must provide insurance to at least 95% of full-time employees or pay a fine.
Here’s What’s In Trump’s Healthcare Plan
CLEVELAND, OHIO – SEPTEMBER 29: U.S. President Donald Trump participates in the first presidential … debate against Democratic presidential nominee Joe Biden, moderated by Fox News anchor Chris Wallace at the Health Education Campus of Case Western Reserve University on September 29, 2020 in Cleveland, Ohio. This is the first of three planned debates between the two candidates in the lead up to the election on November 3.
At the first presidential debate on September 29, moderator Chris Wallace asked President Trump, “What is the Trump healthcare plan?“
In the weeks since, the president’s team hasn’t exactly been forthcoming with details. But President Trump has hardly been inactive on health care during his term. In fact, his administration has taken a number of important but underappreciated steps to boost consumer choice and affordability in the healthcare marketplace.
Take the administration’s 2018 rule expanding access to association health plans. Under these plans, groups of small businesses or self-employed workers can band together to enroll in large-group insurance coverage. In some instances, a large-group plan can offer savings of nearly 20% compared to a small-group plan with the same benefits.
Before the rule was promulgated, small businesses had to have a “commonality of interest” aside from providing health insurance in order to sponsor an association plan. They also had to have at least one employee, so self-employed workers couldn’t join.
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Analysis: Bidencare Or Trumpcare Health Plans Will Affect The Us Economy Differently
By Ann Saphir
6 Min Read
– Democratic presidential candidate Joe Biden wants to expand the Affordable Care Act, President Barack Obamas signature healthcare legislation, and then name it after himself.
Republican President Donald Trump wants to end it altogether, and replace it with something that has yet to be defined.
An ongoing debate over which approach is better for the economy is partly about price tags. Bidencare is forecast to increase federal healthcare spending by $2 trillion or more over 10 years. Trumps approach is to hold federal spending stable or reduce it.
Bidencare supporters emphasize the stimulative effects of government spending, especially in a period of economic distress, and the benefits of insuring more people in the middle of a pandemic. Those who prefer Trumps approach say it would avoid debt or tax increases they say would drag on future economic growth.
The United States has about 30 million people without health insurance tmsnrt.rs/3mzqQxC now, down from about 46.5 million in 2010, when the ACA was passed.
Graphic – Under ACA, a drop in the number of uninsured:
Bidencare would cut that figure by a further 15 million to 20 million, an analysis by the Committee for a Responsible Federal Budget estimates. Trump isnt expected to try to reduce that.
What Is Trump’s Healthcare Plan It Looks A Lot Like Obamacare
- For years, Republicans have lambasted Obamacare, and promised that a full replacement for the Affordable Care Act is in the works.
- But more than 10 years after the ACA was signed into law, no major GOP replacement plan has surfaced.
- Trump’s administration has instituted incremental changes to the landmark healthcare law, and zeroed out the universal coverage mandate.
- Evidence suggests he would do more of the same if given a second term, largely leaving the ACA alone.
- Biden, if elected, would likely usher in a different set of tweaks to the law: he’s floated the ideas of a public option, and more health insurance tax credits available to middle- and upper-class Americans on ACA plans.
President Trump talks a lot about getting rid of President Obama’s landmark Affordable Care Act, which has extended health insurance to 20 million more Americans.
But the truth is that Trump and Republicans in Congress haven’t unified behind replacing Obamacare at all.
Trump’s domestic policy chief Brooke Rollins recently told Business Insider that a backup for the ACA is still “being worked on.”
Ezekiel Emanuel, a health policy expert who was an architect of the original ACA in the Obama administration, is skeptical that any major Republican changes to his legislation are truly in the works.
Perhaps that’s because Republicans don’t really want to get rid of the whole ACA.
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Ahca Vs Aca And The Federal Invisible Risk Sharing Program
An important difference between Obamacare and Trumpcare is the creation of the Federal Invisible Risk Sharing Program. This program has been introduced as part of the AHCA. The Federal Invisible Risk Sharing Program is a pool of funds the government sets aside to assist insurance companies in covering people with high medical expenses. These risk pools are invisible to consumers because the consumers do not know they are in the risk pool. When consumers maintain health coverage, they are expected to pay the same cost for insurance as healthy people.
The ACA has used a different system that reimbursed insurance companies for expensive enrollees who cost more than $45,000 per year. Under the invisible risk-sharing program, insurers would need to identify high-risk patients in advance and place them and their premiums into the high-risk pool. The pool would then pay the patients medical costs beyond a lower threshold of around $10,000. While different, both programs use public funds to lower premiums by reducing the costs to insurance companies.
The Effects Of Trumpcare
Its hard to say exactly what the new version of the bill may look like, but here are some things we know about the version of the bill that passed through the House of Representatives and was proposed to the Senate:
- The Obamacare “individual mandate” that requires everyone to have health insurance would be repealed. Some experts contend it could be one factor that contributes to 24 million more uninsured Americans.
- Subsidies granted to lower-income Americans for the purchase of health insurance would be replaced by tax credits.
- States could obtain a right to waive currently federally-mandated essential health benefits.
- States could obtain a right to charge more for preexisting conditions, but some of those costs can be offset by subsidies offered to people with such conditions.
- Medicaid expansions introduced during the Obama administration would be phased out.
Its important to keep in mind that if Trumpcare does goes into law, it may look quite different than the version outlined above.
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The Better Care Reconciliation Act
The Better Care Reconciliation Act was a revised edition of the AHCA and represented the second attempt at installing Trumpcare. This bill was similar to the AHCA but kept some of the features of Obamacare, such as tax provisions to help pay for low-income insurance premiums.
The BCRA was never voted on in its original form as it became clear the bill would not pass Congress due to opposition from several Republican senators.
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.
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.
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A Trump Executive Order Ended Subsidies For Obamacare Tax Credits
Trump signed an executive order in October 2017, eliminating subsidies provided to help people pay for their health insurance.
Under Obamacare, tax credits were available to people who earn up to 250% of the federal poverty level . These tax-credit subsidies help cover the cost of annual deductibles in Obamacare marketplace plans.
The executive order signed by Trump did away with those subsidies.
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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New Trump Rule Requires Health Plans To Disclose Costs Up Front
WASHINGTON Trying to pull back the veil on health care costs to encourage competition, the Trump administration on Thursday finalized a requirement for insurers to tell consumers up front the actual prices for common tests and procedures.
The late-innings policy play comes just days ahead of Election Day as President Donald Trump has been hammered on health care by Democratic challenger Joe Biden for the administrations handling of the coronavirus pandemic and its unrelenting efforts to overturn Obamacare, the 2010 law providing coverage to more than 20 million people.
A related Trump administration price disclosure requirement applying to hospitals is facing a federal lawsuit from the industry, alleging coercion and interference with business practices.