Repeal or Replace?
Published in The Journal Record
December 14, 2016
When Donald Trump takes the oath of office on January 20, 2017 it is presumed he will mention one of his most fervent campaign promises, and that is to repeal and replace the Affordable Care Act (aka Obamacare). This was a campaign commitment that was cheered wildly in the months before the election but the achievement will be far more difficult than most assume.
The first problem with an immediate repeal is that millions who received subsidies to purchase health care could immediately lose their insurance. To summarily terminate millions’ health coverage may well be a substantial black eye for the new president and the Republican Party. Therefore, I believe the administration and the leadership in Congress will look for some sort of phase-out of the insurance currently held, and a phase-in to whatever product is produced by a Republican government. This “phase out” period may, in fact, take several years to accomplish.
The second problem is that the new administration clearly has not settled on a comprehensive alternative. Besides some vagaries about a market driven plan and selling insurance across state lines there is really very little clue as to what a replacement vehicle might look like. We can, however, take a clue from the recent appointment of Georgia Representative Tom Price, an orthopedic surgeon by training. His announced HR 2300 has some relatively clever ideas about using the tax system through tax breaks and incentives to acquire insurance. It, however, does not speak to reforming the health care system itself. The fact that health care costs have increased faster than general inflation for the last twenty years is surprisingly not addressed in his plan.
With all of its deficiencies the ACA undertook to establish new payment systems that could alter the delivery of health care services and perhaps have a chance to control runaway costs. The repeal effort for the Republican Congress may be the easy part (assuming a phase in/phase out) but the replacement piece will prove to be much more challenging as there is very little agreement on what a new plan should look like.
The hope is the new administration and Congress will be able to craft a revision that maintains coverage without the staggering premium increases we have seen while keeping the popular consumer benefits (such as allowing for pre-existing conditions).