Past Updates On Trumpcare
The next section includes some past updates on TrumpCare so you can get a sense of what was promised or tried in the past and compare that to what is happening now. A lot of small changes have happened very quickly so forgive the notes.
UPDATE: Trump and Republicans in Congress had stated that they would seek to repeal ObamaCare within Trumps first hundred days in office. True to their word the process of repeal has begun. Trump has signed an executive order on ObamaCare. The American Health Care Act is on the table. After a meeting with President Obama, President-elect Trump suggested he would either amend ObamaCare or repeal and replace it, not just repeal it, and would keep key provisions like guaranteed coverage for preexisting conditions and allowing kids to stay on their plans until 26. More recently, Trump promised simultaneous repeal and replace,insurance for everybody, and he doubled down on his longstanding promise of negotiating with drug companies. Unfortunately, after a meeting with drug companies, Trump backed away from allowing negotiations.
TIP: The GOP forever altered the lexicon when they called the Patient Protection and Affordable Care Act ObamaCare. With this in mind, Trumps healthcare plan has been unofficially dubbed TrumpCare. This is true even though no formal plan is on the table yet.
Creating Fear That Will Discourage Enrollment In Health Coverage Programs
The Department of Homeland Security and the Department of State issued immigration rules in 2019 that will make it much more difficult for people with low or modest means to immigrate to the United States or for people already here to gain permanent resident status or extend or modify their temporary status. These complicated rules, along with other Trump Administration policies, have led many families that include immigrants to forgo Medicaid and other assistance programs for which theyre eligible despite the fact that most people who qualify for the programs identified in the rules will not undergo the public charge assessment that the rules radically changed. Beginning February 24, 2020, DHS immigration officials will be able to reject immigration applicants if they have received, or are judged likely to receive in the future, any of an array of benefits, including Medicaid. Timing for the DoS implementation of the policy has not yet been announced.
Who The Order Affects
Trumps executive order aims to help further expand Medicare Advantage plans, which are private insurance plans now used by about a third of the nations 61 million Medicare enrollees.
Most seniors and disabled persons on Medicare are enrolled in basic Medicare, which is managed by the federal government. Some Democrats proposals would expand this type of Medicare and either reduce or exclude the role of private health insurers in favor of a government-run program.
Basic Medicare consists of coverage for hospital and nursing home costs and expenses for doctors, outpatient services, and durable medical equipment .
The government pays only 80 percent of covered Part B expenses, leading many Medicare enrollees to also buy private Medigap insurance plans to plug this and other coverage gaps in basic Medicare. People with basic Medicare also buy separate Part D drug plans, which are also run by private insurers.
Medicare Advantage plans, by contrast, can bundle all Medicare coverage into a single package. The plans usually cost less than add-ons to basic Medicare. The plans cover people only for services provided by doctors, hospitals and other care providers in a plans provider network, and usually limit coverage to an enrollees home market. People with basic Medicare, by contrast, are covered for care anywhere in the U.S. from participating Medicare providers.
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Trump Broke This Promise From The Beginning
This is Trump on the campaign trail in 2015:
I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.
Donald J. Trump May 7, 2015
Trumps budgets and the policies he has supported around health care and government spending in Congress reflect the opposite. Some of this can be attributed to Trumps appointed budget chief Mick Mulvaney the former Congress member who was part of the ultraconservative Freedom Caucus has long rallied for cutting Medicare, Social Security, and Medicaid.
In fact, Mulvaney once bragged to a Politico reporter that he tricked Trump into accepting a proposal to cut Social Security by calling SSDI just disability insurance spinning it to the president as general welfare reform. The idea has been in every single one of Trumps budget proposals to Congress since the president came to office.
Then there was the Republican Obamacare repeal push every bill proposed massive cuts to Medicaid in order to pay for tax cuts elsewhere. Trump supported every iteration of Republicans Obamacare repeal-and-replace bills. He even held a party for House Republicans in the White House Rose Garden when the lower chamber of Congress narrowly passed a proposal that slashed more than $800 billion from Medicaid over 10 years.
Now his policy positions around those programs break from that promise.
Trump Administrations Aca Repeal Suit Stance Is In Line With Its Health Care Agenda
President Trump has made clear that his goal remains to repeal the Affordable Care Act , including its expansion of Medicaid to low-income adults, and to impose rigid caps on the federal governments Medicaid spending. While Congress considered and rejected a series of proposals to cut Medicaid and repeal the ACA in 2017, the Administration has continued to pursue the overarching policy goals of those bills through its budget proposals, litigation seeking to overturn the entire ACA, and administrative actions. Restrictions it has put in place administratively have already cost many thousands of people their health coverage and access to care and could harm millions more.
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Opting Out Of Medicare Part A
The first proposal would allow individuals to opt out of Medicare Part A without the move interfering with their Social Security benefits.
The proposal isn’t a new one. A court case from a decade ago challenged the rule, and is supported in some conservative circles.
Currently, if you start taking Social Security before age 65, you automatically get signed up for Part A when you hit that Medicare-eligible age. Waiting until after age 65 to tap Social Security results in automatic sign-up, as well. And while you could choose to opt out of Part B if you have coverage elsewhere, you must remain enrolled in Part A or pay a steep price.
“The only way they can opt out of Part A is either not to apply for Social Security in the first place or, if they already have, repay the Social Security Administration all the money they’ve received and anything Medicare has spent on their health care,” said Medicare expert Patricia Barry, author of “Medicare for Dummies.”
She explained that the rule has been around since the program’s beginnings, when most people retired at age 65 and started both Social Security and Medicare at that time.
The budget notes that the change would have no effect on revenue.
The Parties Have Been Ordered To Submit A Joint Status Report Identifying Whether And How This Case Should Proceed By No Later Than April 1
A rebate rule the Biden Administration had already delayed until March 22 has been pushed out further to January 1, 2023.
The rule, scheduled under the Trump Administration to take effect on January 1, 2022, is being delayed by court order issued January 30, in a lawsuit by the Pharmaceutical Care Management Association against the Department of Health and Human Services.
The case is being held in abeyance pending the duration of HHS’s review of the November 20, 2020 rule. The parties have been ordered to submit a joint status report identifying whether and how this case should proceed by not later than April 1.
According to a statement from PCMA, the delay in the effective date will give the Biden Administration the necessary time to review the entire rebate rule’s impact on Medicare Part D and its enrollees.
WHAT’S THE IMPACT?
The Trump rule received pushback when it was first announced, with opponents claiming the move would not lower drug prices, and instead would increase costs for all beneficiaries, with insurers using the rebates to lower premiums.
In February 2019, HHS actuaries said the rule would increase Medicare premiums for all seniors by 25%, said Eyles, adding that the rule would give drugmakers another $100 billion bailout and have taxpayers foot the bill for higher costs.
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Continued Efforts To Repeal Obamacare
After three versions of Trumpcare failed to move forward in a Republican-controlled House and Senate in 2017, Democrats regained control of the House after the 2018 midterm elections.
Without the support needed to pass a bill that would repeal and replace Obamacare, President Trump turned to other measures to chip away at the ACA.
The Tax Cuts and Jobs Act is the most notable of those efforts.
This tax reform bill was passed by President Trump in late 2017. It included the elimination of the tax penalty required for those who did not maintain health insurance, otherwise known as the individual mandate that served as the foundation of Obamacare.
The Cost Of Trumpcare
The Committee for a Responsible Federal Budget did a review of Trumps healthcare plan. The following article shows a breakdown of costs: MEASURING TRUMPS HEALTHCARE PLAN. The result is a cost of roughly $550 billion over ten years under conventional scoring and about $330 billion with dynamic scoring .
Note that this analysis does not include Mr. Trumps call to negotiate aggressively for Medicare drugs, a policy that is not listed on his website. He has previously claimed that $300 billion a year could be saved through negotiation, a claim we rated as false because Medicare will only spend an average of $111 billion each year on prescription drugs. Based on previous estimates by CBO, actual savings would likely be small or negligible.
NOTE: The plan assumes a full repeal of ObamaCare before replacing it. While this is possible given Trumps statements, it isnt necessarily what we would get from the future President Trump.
NOTE: Like him or hate him, Trump has mentioned some critical health policies like expanding Medicaid and debating drug costs for Medicare. These didnt make it into the Trump plan as written, but it would be a mistake to overlook the benefits of strategies like debating drug prices for Medicare.
|10-Year Estimates of Healthcare Reform to Make America Great Again|
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Trump Opens Door To Cuts To Medicare And Other Entitlement Programs
The president signaled a willingness to scale back Medicare, a shift from his 2016 platform of protecting entitlement programs.
WASHINGTON President Trump suggested on Wednesday that he would be willing to consider cuts to social safety-net programs like Medicare to reduce the federal deficit if he wins a second term, an apparent shift from his 2016 campaign promise to protect funding for such entitlements.
The president made the comments on the sidelines of the World Economic Forum in Davos, Switzerland. Despite promises to reduce the federal budget deficit, it has ballooned under Mr. Trumps watch as a result of sweeping tax cuts and additional government spending.
Asked in an interview with CNBC if cuts to entitlements would ever be on his plate, Mr. Trump answered yes.
At some point they will be, Mr. Trump said, before pointing to United States economic growth. At the right time, we will take a look at that.
Mr. Trump suggested that curbing spending on Medicare, the government health care program for the elderly, was a possibility.
Were going to look, he said.
Spending on Social Security, Medicare and Medicaid is expected to cost the federal government more than $30 trillion through 2029, according to the Congressional Budget Office.
In a tweet in May 2015, a month before he formally began his campaign, Mr. Trump discussed another Republicans promises to keep entitlements intact, former Gov. Mike Huckabee of Arkansas.
A Summary Of Trumps Order And Hhs Regulations
The Trump Executive Order does little more than instructing the IRS not to enforce the mandates as harshly. The results are complex. See Trump Executive Order on the ObamaCare Mandates !
Unlike the Order, the Trump Administration HHS regulations change a lot.
In summary, the regulations:
- Make open enrollment shorter.
On the plus side, the deregulation will likely lower costs a bit for those full-time employees with higher incomes and health coverage who will remain at their job .
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Trumps Plan To Privatize Medicare
Last week, President Donald Trump signed an executive order titled Protecting and Improving Medicare for Our Nations Seniors. The order is the latest example of how Trump says one thing while doing another. Rather than strengthening Medicare, Trump envisions turning large swaths of the 54-year-old program for the elderly over to the private sector while directing the federal government to dismantle safeguards on seniors health care access, shift costs onto beneficiaries, and limit seniors choice of providers.
Among other things, the executive order lays out a path to:
- Shift the Medicare program toward private plans
- Expand private contracting between beneficiaries and providers, putting seniors at risk for higher costs and surprise medical bills
- Further restrict seniors choice of providers in Medicare Advantage
- Expand Medicare Medical Savings Accounts as a tax shelter for the wealthy
A Shift Toward Medicare Privatization
Today, about one-third of seniors are enrolled in private plans through Medicare Advantage the other two-thirds are in traditional, fee-for-service Medicare. The share of beneficiaries enrolled in Medicare Advantage has grown over the past two decades. Medicare Advantage attracts a relatively healthier, less expensive pool of enrollees than that of traditional Medicare, and its per-beneficiary spending is lower. Some of that difference is attributable to lower health care utilization, although local market conditions and beneficiary health status also contribute. A number of studies have shown how Medicare Advantage plans profit from selection by attracting relatively healthier enrollees while also gaming the Centers for Medicare and Medicaid Services risk adjustment program to make their enrollees appear sicker. Medicare Advantage plans also enjoy distinct advantages over the traditional Medicare program, including integrated plan designs and the ability to avoid providers involved in graduate medical education.
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