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Trump’s plan for health care beyond repeal and replace

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President-elect Donald Trump ran much of his campaign on the promise of repealing and replacing the Affordable Care Act of 2010, commonly known as “Obamacare.”  This was in line with the Republicans’ strategy and House Speaker Paul Ryan’s own proposal dubbed The Patients’ Choice Act.

Trump has broken down his plans into three points beyond repealing Obamacare and implementing Ryan’s proposal.  

“Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage.”

High-risk pools were where people with extreme pre-existing conditions went to before the passage of the ACA. They were effectively an expansion of the Medicaid program, except instead of participants being unable to afford health insurance, they were unable to even qualify for health insurance.

The GOP argues that states are more equipped to administer aid programs to their populations than the federal government. Critics have argued that high-risk pools created situations that were prohibitively expensive, drawing data from the Pre-Existing Condition Insurance Plan that was created as an intermediary under the ACA until the full passage of the law.  

“Allow people to purchase insurance across state lines, in all 50 states, creating a dynamic market.”

This provision already exists in some capacity, since the ACA explicitly allows for the creation of interstate markets. However, it comes with the stipulation that the insurer must adhere to the requirements of each state in which it’s participating, as outlined in Section 1334 of the ACA. It’s unclear in Trump or Ryan’s proposal whether insurers would be held to the rules of the state they’re headquartered in or to whichever state in which they’re participating.

“Maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will better serve their low-income citizens.”  

The block grant model for changing Medicaid has been popular among Republicans for some time. Under this model, each state would get a pre-determined amount of money from the federal government that would go toward Medicaid, and then the state would decide how to spend that money. Rep. Tom Price, R-South Carolina, who is Trump’s choice for head of the Department of Health and Human Services, sponsored a bill that would end up cutting $2.1 trillion over a decade in a shift to block grants.  

Upon review of a similar bill from Speaker Ryan in 2012, the Kaiser Commission on Medicaid and the Uninsured predicted that states would remove between 14- and 20-million people from Medicaid in that decade. Ohio currently enrolls 2.4 million people in its Medicaid program as of October 2016.

Trump’s health care plan seems to be in line with the philosophy of the GOP, particularly in regard to how to handle the ACA. But with Trump’s comments that he would be open to amending instead of repealing the bill, the question becomes how will the GOP dismantle the massive piece of legislation and implement its reform in a timely fashion.

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