After seven years of opposing Obamacare, Republicans are laying the stakes for Trumpcare, which is going to revamp the Affordable Care Act that passed seven years ago.
America’s healthcare system is a maddening hodgepodge that is unparalleled by international standards. President Barack Obama attempted to tackle our Frankenstein-like system through his stab at healthcare reform. Unfortunately, Obamacare created as many problems as it solved by not addressing the biggest problem in American healthcare: runaway cost.
For many, Trumpcare appears to be Obamacare with a few minor tweaks, something that will anger certain conservatives. For others, Trumpcare will leave millions of our most vulnerable citizens without the insurance coverage they need, and that’s bound to enrage a wide range of people, especially more liberal folks.
It’s important to keep in mind that the bill is still coming together and will need to make it through both the House and the Senate before it’s signed by President Donald Trump. We do know that this new law will embrace more free-market principles that Republicans crave. What we don’t know is how these changes will play out, and how it will affect a sector that makes up nearly one-fifth of our national economy.
There are a few general categories for healthcare coverage that you should be aware of in order to make sense of health-care policy.
Government-provided health-care programs include Medicaid for the poor and Medicare for seniors over 65. The biggest swath of the population (about 50 percent) gets insurance through employers, while a significant minority buy insurance on their own on the Health Insurance Marketplaces or exchanges. Trumpcare includes changes for Medicaid recipients and people who buy their own insurance on the exchanges.
Obamacare banned insurers from denying coverage because of pre-existing conditions, something that was horrible for millions of Americans. Contrary to many fears, Trumpcare will keep this popular Obamacare policy intact.
What will disappear are the generous subsidies that are available for buying insurance on the exchanges. This is bound to affect millions of low- to middle-income people who currently pay very little out-of-pocket for their insurance.
Also targeted are people who have coverage through Medicaid. This is where it gets a bit confusing people some states expanded Medicaid in recent years, while others didn’t. Either way, Trumpcare will freeze enrollment in expanded Medicaid and later impose “per capita caps’ by 2020. Essentially, Medicaid is being pared back significantly.
The fines for not having insurance are going away, but insurers will be allowed to charge you a 30 percent penalty if you don’t stay insured. Also, there will be a tax credit that becomes available in 2020 to help you buy insurance, and that amount increases with age.
Additionally, insurance companies will be allowed to charge up to five times as much for older people. This not-so-minor detail is bound to anger older people and probably cost several politicians their re-election.
Fiscal conservatives will rejoice as all Obamacare taxes will be phased out, as will requirements to be insured and employer mandates to provide health insurance. This will save the government, businesses and consumers a large sum of money.
Sadly, Trumpcare still dodges the elephant in the room — cost controls. Conservatives promised to allow insurance policies to be sold across state lines, which would spur competition and lower premiums. This plan won’t allow that, and it won’t address the growing problem that millions of us face: In many cases, only one insurance company offers coverage in a given area. Exchanges in many states have collapsed and are in desperate need of more competition.
Already, some big-name centrist Republican senators have expressed their concerns about the current House draft’s changes to Medicaid, saying that the proposed law doesn’t “adequately protect people.” More conservative Republican senators have also expressed their doubts and will likely denounce this reform as not going far enough to dismantle Obamacare.
Compromise is a necessary part of our legislative process, and it’s going to be hard to get everyone in the Republican party to sign off on these massive changes.
There are certain political realities that will be hard to swallow. Taking away subsidies from millions of low- and middle-income citizens is bound to produce massive political fallout. Raising premiums for older folks also is going to cause a major uproar. Taking away entitlements is never an easy ride for elected officials.
Welcome to where the rubber meets the road in the world of healthcare policy. President Trump admitted, “nobody knew healthcare could be so complicated,” and the Republican party is just getting started on a long road to policy change. Look for severe political turbulence in the near future.
This article was originally featured on GenFKD.org
David is the Editor of Bold. He's especially passionate about millennial economic empowerment. A former local news reporter, David is originally from the Little Havana area in Miami, and later became a pioneer resident of the Disney-inspired town of Celebration, Florida. David holds a Master’s in Public Policy from the Harvard Kennedy School.