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During this year’s often bitter presidential campaign, Candidate Donald Trump was sharply critical of the Affordable Care Act (popularly referred to as Obamacare). He vowed that, if elected, repealing and replacing the ACA would happen on “day one of the Trump administration.” But now, what can we expect from President-elect Donald Trump? Repealing Obamacare is the easy part. Fashioning a replacement plan is the hard part.
According to the U.S. Department of Health and Human Services, “an estimated 20 million people gain(ed) health insurance coverage between the passage of the law in 2010 and early 2016—an historic reduction in the uninsured.” However, taking away health insurance for that many people may come at a high political cost. Michael Sparer, chair of health policy and management at Columbia University’s School of Public Health, offered this observation to CNN: “I don’t think anyone would want to pass a bill overnight that cost 20 million people their health insurance.” Now, the question we at Nash Disability Law are frequently asked is: “What are the prospects for those people that President-elect Trump has promised will be ‘taken care of’”?
Perhaps we can get a glimpse at the thinking of the Trump administration by looking at the state of Indiana. Indiana is, of course, where Mr. Trump’s Vice President-elect, Mike Pence, is Governor. “(Indiana’s) Medicaid expansion under the Affordable Care Act was designed by Seema Verma, a consultant who has been nominated by President-elect Donald Trump to lead the US agency that oversees Medicare and Medicaid,” according to a news story from Crain Business. “And with congressional Republicans seeking to repeal and replace the ACA and make other changes to Medicaid, Indiana’s system could be seen as a template for a Medicaid overhaul in other states.”
Under Verma’s proposed Medicaid plan, participants will pay every month into a health savings account much like paying an insurance premium. How much they pay is income-based. If they fail to pay, it means they can be kicked out of the program. Additionally, there is a monetary penalty for using an emergency room for a non-emergency medical situation. “Pence and Verma say the plan would make people act more responsibly in seeking health care,” Crain Business reports. Given the tough talk on the campaign trail, it seems very likely that the Trump administration will give individual states a lot of freedom to follow Indiana’s lead and experiment with their Medicaid programs.
At Nash Disability Law, we have seen tremendous progress with the ACA to date. We have questioned our clients carefully about their access to health care long before the ACA, during its introduction, and again more recently. While there are still problems, such as the 47-year-old waitress from Bensenville with a myriad of health problems and a quoted premium which is far too high, our impression has been that the Affordable Care Act has been a tremendous help to countless prospects and clients. For many hardworking and underpaid Americans, premiums and complicated rules are hurdles that become insurmountable obstacles—so in reality, they become a denial of insurance coverage. It is our hope that the next administration improves upon the Affordable Care Act.