After the Election: What Will the Trump Administration Mean for Healthcare?

Contents Key Polling Data Impacts of ACA Repeal Proposed ACA Replacement Policies Policy Fact Sheets Shopping Across State Lines High-Risk Pools Premium Support in Medicare Premium Support in Non-group Market High-Deductible Health Plans/Health Savings Accounts Broaden Age Rating Bands Medicaid Block Grants Procedural Options Background on Proposed Cabinet Appointments Opportunities to Take Action

Key Polling Data

Kaiser Family Foundation Post-Election National Poll: Many ACA provisions are supported by a majority of Democrats, Republicans and Independents; a minority favor outright repeal with no replace.

Impacts of ACA Repeal

• Implications of Partial Repeal of the ACA through Reconciliation, Urban Institute (Dec. 6, 2016):  Analysis of what would happen to healthcare and coverage if the ACA were repealed without an immediate replacement.
• Impact of Affordable Care Act Repeal, Center on Budget and Policy Priorities (Dec. 7, 2016): State profiles showing the impact partial ACA repeal using the same Urban Institute analysis.
• Republican Bill Vetoed in January Would Have Reversed Almost All of Health Reform’s Coverage Gains, Edwin Park, CBPP Blog post (Nov. 16, 2016): Analyzes a health reform bill passed by the GOP-led Congress in early 2016 and how it would have reversed gains made after the passage of the ACA. The bill was vetoed by President Obama.
• Republican ACA Repeal Bill Would Unravel the Market Even Before It Goes into Effect, Center for American Progress (Nov. 16, 2016): A critical look at how ACA repeal could destabilize insurance markets.

Proposed ACA Replacement Policies

• Trump Campaign Platform, Trump Campaign Website
• “Taking Stock of Health Reform: Where We’ve Been, Where We’re Going,” Timothy Jost, Health Affairs Blog (Dec. 6, 2016).
• Donald Trump's Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit, Commonwealth Fund, (Sept. 23, 2016): Issue brief looking at the ways in which President-elect Trump’s health reform proposals would impact insurance coverage and spending.
• House GOP Proposals Would Make Health Coverage Less Secure for All Americans, Center for American Progress (Aug. 1, 2016): In-depth critical analysis of how GOP health reform proposals would affect Medicare, Medicaid, and the private insurance market.  

Policy Fact Sheets/Blogs

Shopping Across State Lines

• FAQ: Selling Health Insurance Across State Lines, Kaiser Family Foundation (Jan. 25, 2011): A primer on arguments for and against the practice.
• Selling Insurance Across State Lines: An Assessment of State Laws and Implications for Improving Choice and Affordability of Coverage, Georgetown University, Center on Health Insurance Reforms (October2012): Analysis of legislation enacted in six states allowing the sale of health insurance across state lines.  No insurers have opted to enter these markets from out-of-state and the legislation has failed to meet its goals. This is attributed largely to the localized nature of healthcare delivery.
• Trump, House GOP Proposals Allowing Insurers to Sell Across State Lines Would Undermine Insurance Markets, Edwin Park, CBPP (Nov. 17, 2016): A critical analysis of proposals allowing health insurers to sell across state lines.
• “The Problem With GOP Plans to Sell Health Insurance Across State Lines,” The Upshot blog, New York Times (Aug. 31, 2015): Potential out-of-state insurers face financial and logistical challenges in establishing effective provider networks. Critics warn of a race-to-the-bottom as insurers move to states with the most lenient regulations.  

High-Risk Pools

• High-Risk Pools for Uninsurable Individuals, Kaiser Family Foundation (Aug. 1, 2016).
• Trump, House GOP High-Risk Pool Proposals a Failed Approach, Edwin Park, CBPP (Nov. 17, 2016): A critical analysis of GOP proposals to enact national high-risk pools.
• Consumer Guide to High-Risk Health Insurance Pools, National Association of Health Underwriters:  A brief primer on high-risk pools.
• Why High Risk Pools (Still) Won’t Work, Jean Hall, The Commonwealth Fund (Feb. 13, 2015): Historical experience shows that high-risk pools are prohibitively expensive to administer, prohibitively expensive for consumers to purchase and result in lower-quality coverage.
• Realizing Health Reform’s Potential: Why a National High-Risk Insurance Pool Is Not a Workable Alternative to the Marketplace, Commonwealth Fund (December 2014): Issue brief examining high-risk pools and why they are not a workable solution for high-need patients.

Premium Support in Medicare

• House Republican Health Plan Would Radically Restructure Medicare, Paul Van de Water, CBPP (July 26, 2016): Explains the ways in which House Speaker Paul Ryan’s A Better Way would restructure Medicare.
• Turning Medicare Into a Premium Support System: Frequently Asked Questions, Kaiser Family Foundation (July 21, 2016):  An issue brief explaining proposals that would reform Medicare such that the government would provide beneficiaries with a fixed amount of “premium support” with which individuals would purchase health insurance.
• The High Cost of Charging Older People Much Higher Premiums, Sara Collins, Commonwealth Fund (Aug. 30, 2016):  Looks at the effect of proposals to increase the “age-band” allowing insurers to charge older adults more than younger adults.

Premium Support for Non-group Market

• What Happens if the ACA’s Tax Credits are Replaced with Premium Support, Commonwealth Fund (Nov. 24 ,2015): A financial analysis indicates premium-support models could place financial burdens on low-income and older individuals.

High-Deductible Health Plans/Health Savings Accounts (HDHP/HSA)

• “HSA Balances Climb But Benefits Reward Wealthier Consumers Most,” Kaiser Health News (Dec. 2, 2016):  Tax advantages of HSAs skew heavily toward people with higher incomes: 58% of tax returns claiming HSA-deductible contributions in 2013 were from households earning more than $100,000.
• Health Savings Accounts and High-Deductible Health Plans: Why They Won't Cure What Ails U.S. Health Care, Congressional Testimony, Sara Collins, Commonwealth Fund (Sept. 1, 2006): Testimony discussing the downsides of HSAs and HDHPs.
• Rethinking Consumerism in Healthcare Benefit Design, Healthcare Value Hub (April 2016).

Broaden Age Rating Bands

• The High Cost of Charging Older People Much Higher Premiums, Sara R. Collins, Commonwealth Fund (Aug. 30, 2016).

Medicaid Block Grants

• Medicaid Block Grant Would Slash Federal Funding, Shift Costs to States, and Leave Millions More Uninsured, Edwin Park, CBPP (Nov. 30, 2016):  Explains anticipated effects of block granting Medicaid, including cost-shifting to states and anticipated benefit reductions.
• Block Grants and Per Capita Caps Would Dismantle Medicaid as We Know It, Community Catalyst (December2016): Fact sheet explaining block grants and the reasons they would potentially reduce access to and quality of Medicaid coverage.
• What Would Block Grants of Limits on Per Capita Spending Mean for Medicaid?, Sara Rosenbaum, et al., Commonwealth Fund (Nov. 18, 2016): An issue brief that examines proposals to block grant Medicaid and how they would create fundings gaps that could lead to a narrowing of coverage and benefits.

Procedural Options

Budget Reconciliation

• Introduction to Budget Reconciliation, Center on Budget and Policy Priorities (updated Nov. 9, 2016):  Explains how reconciliation works and how the new administration could use it to advance their agenda.
• Republican ACA Repeal Bill Would Unravel the Market Even Before It Goes into Effect,  Topher Spiro and Thomas Huelskoetter, CBPP (November 2016): Argues that repeal and delay doesn’t work.
• “GOP Eyes Lightning Strike on Obamacare to Kick Off Trump Era,” Bloomberg Politics (Nov. 29, 2016): How the GOP will likely use the budget reconciliation process to pass repeal of Obamacare immediately once Trump takes office, with a provision for its full replacement to be enacted as late as two later.

Background on Proposed Cabinet Appointments

• HHS Secretary Nominee Price’s Health Plan Would Severely Weaken Health Coverage and Consumer Protections, Edwin Park, CBPP (Dec. 1, 2016): Analyzes the health plan put forward by President-elect Trump’s nominee for Secretary of Health and Human Services, Rep. Tom Price (R-GA).
• Tom Price: Everything You Need to Know About Trump’s Pick for Health Secretary, ABC News (Nov. 29, 2016):  A brief bio of Rep. Tom Price (R-GA)

Opportunities to Take Action

• Consumer Report Petition

• Consumer Reports: Share your High-Deductible Health Plan Story

• Families USA Petition