Trumpcare: Goodbye Affordable Care Act

The US presidential election and the candidate’s campaigns have dominated most of 2016 and seemed to painfully stretch out longer than they actually were, filled with scandals and surprises alike. One of which is the planned revocation of the Affordable Care Act to replace it with Trumpcare. What could sound scarier?

Now that Donald Trump victoriously emerged from the train wreck called the presidential election, it is time to actually look at what Trump has said and prepare for what’s to come in the next four years.

One of the many things Trump promised during his campaign was the revocation of the Affordable Care Act (also known as ACA or Obamacare), which in his eyes was a step backwards in healthcare, although he wouldn’t go into too many specifics, which made it hard to imagine how and what his vision of the “perfect healthcare” actually was at that time.

Thankfully, a lot has happened since Trump got elected and we now know who’s going to be the face of the Department of Health and Human Resources, enabling us to take a look on what might happen as soon as the new administration is in place.

How it Went Down So Far

In November, a couple of weeks after his election, Trump nominated Tom Price as the new HHS Secretary, which isn’t too surprising considering Price is one of the biggest Obamacare opponents and already revealed his own solution to the problem, the Empowering Patients First Act. The document, which can be viewed on his website, is probably the most comprehensive collection of any Republican to completely replace the Affordable Care Act, including Paul Ryan’s Patients’ Choice Act.

But all of this isn’t exactly new. Even though the president-elect was extremely shy in going into detailed plans for his much-proclaimed healthcare overhaul, it was clear from the get-go that he not only wanted to repeal the Affordable Care Act but to reshape the healthcare system to more closely resemble the free market.

Free market principles and the remains of the Affordable Care Act

The American healthcare system is a comparably complex construct and there are a lot of things to look at and even more things that are going to change, certainly far more than we can take a look at now. What we are trying to do is looking at the direction the American healthcare system might be going and if those changes could be for better or for worse.

The Affordable Care Act was by no means a perfect solution when it was introduced, but it was a step in the right direction in terms of bringing health insurance, namely Medicaid, to more people, most of which couldn’t previously afford any health coverage. Statistics released by the Census Bureau show that the uninsured rate was indeed cut in half between 2011 and 2015, by including more people in the Medicaid program. Medicaid is a program administered by the states with funding from the federal government and it should be mentioned, that not all states implemented the Medicaid expansion and therefore some people to this day are not eligible for Medicaid although they would be in other places.

All of those who gained access to health insurance under the Affordable Care Act, however, may very well lose it under the new administration, as most of what brought that access might be gone in a few months time.

Cherry Picking

In his first interview after the election, Trump told reporters that he intends to keep the two most popular features of the Affordable Care Act, one of which prevents insurances to deny coverage based on preexisting conditions and one enabling children to be covered under their parent’s insurance until the age of 26. Looking at Price’s Empowering Patients First Act, this is still the case, however, most of the changes to Medicaid brought by Obamacare would be lost, mostly without an adequate replacement.

The right question to ask now is what will actually replace the current system? We already mentioned that Trump aims for a system resembling the free market. This means empowering insurance companies to sell their products nationwide and not be restricted by state borders, giving the citizens a wider choice and variety thus theoretically bringing prices down through competition as well. Same goes for the pharmaceutical industry, where Trump would like to open markets for cheaper but equally reliable medical products from overseas, again theoretically bringing prices down for the consumers. Additionally, everyone spending money on insurance will be eligible for a tax credit, based on age, which in fact could promote health insurance with younger age groups.

Low Prices Are Not Everything

In the end, this might bring down prices, but then again one has to remember that the US has one of the most expensive health systems in the world and spends way more than many other states with a much lower turnout for their citizens. The ACA did not bring health insurance to as many people as promised or needed, but taking away the Medicaid expansion will make even this little progress void, taking much-needed support away from people and families below the poverty line, which is already pretty low.

But that’s not all. The Medicaid expansion introduced by the Affordable Care Act did make the Medicaid and Medicare programs more financially sound and set the ground for more improvements in the years to come. If those things are taken away and pretty much replaced with a system that enables private companies to take over by free market principles, this could end in a scenario that is not beneficial for anyone.

Nothing is set in stone as of right now, but this might be the road the new administration will go down once they take over. We barely scratched the surface of this topic as there are a million things to consider in a system this huge and complicated. We will have to wait and see what the exact replacement will be but we assume Price’s approach will play a big role in what’s to come.

About Andreas Salmen

Born and raised in Germany, learned a job in IT and Business and ultimately decided that this wasn't exactly where my life was going to end. Left everything behind to become a writing backpacker instead. The world's crumbling away anyway so why not write about it and get a few good Instagram pics on the way, am I right?

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