Trump’s pledge to kill Oba­macare faces re­al­ity check ‘Very much some­thing we’re go­ing to try and keep’

Kuwait Times - - HEALTH & SCIENCE -

WASH­ING­TON: With his shock vic­tory in the race for the White House, Pres­i­dent-elect Don­ald Trump at last is in po­si­tion to de­liver on one of his most stri­dent cam­paign prom­ises: to re­peal Oba­macare. With fel­low Repub­li­cans in con­trol of the US Congress, Trump has the means and os­ten­si­bly a man­date from his party to gut the law. But he may find the re­al­ity is more chal­leng­ing. Exit polls suggest Trump rode to vic­tory in no small part on the sup­port of those bat­tle­ground state vot­ers who strongly dis­liked Pres­i­dent Barack Obama’s sweep­ing health care re­forms, es­pe­cially given ris­ing costs. How­ever, af­ter Trump met Pres­i­dent Barack Obama last week he seemed to backpedal on his in­ten­tions.

Can­di­date Trump vowed to “com­pletely re­peal” the Af­ford­able Care Act and de­scrib­ing it as a “to­tal dis­as­ter.” But af­ter his win, Pres­i­den­t­elect Trump said he hoped to pre­serve two of the most pop­u­lar fea­tures: al­low­ing chil­dren to stay on their par­ents’ plans un­til age 26, and for­bid­ding in­sur­ance com­pa­nies from deny­ing cov­er­age to peo­ple with pre-ex­ist­ing con­di­tions.

‘Death spi­ral’

The lat­ter el­e­ment is pop­u­lar even with Repub­li­can law­mak­ers who have at­tempted on scores of oc­ca­sions to re­peal Obama’s land­mark health re­form.

Trump told the tele­vi­sion news­magazine “60 Min­utes” it was “very much some­thing we’re go­ing to try and keep.” Yet an­a­lysts say keep­ing those fea­tures will be dif­fi­cult if not im­pos­si­ble if Trump’s re­form abol­ishes an­other key part of Oba­macare, the so-called “in­di­vid­ual man­date.” That is the re­quire­ment that Amer­i­cans carry health cov­er­age re­gard­less of whether they are sick or healthy. To cover the cost of pro­vid­ing cov­er­age for sicker pa­tients, health in­sur­ers de­pend on the rev­enue they get from the healthy en­rollees that Oba­macare re­quired to buy in. If that re­quire­ment is elim­i­nated, “that’s ba­si­cally go­ing to cause a death spi­ral,” Sandy Ahn, a re­search pro­fes­sor at Ge­orge­town’s Health Pol­icy In­sti­tute, told AFP.As in­sur­ers lose in­come from de­part­ing healthy con­sumers, they will raise premi­ums, putting cov­er­age out of reach for many.”The health care markets will look like they did be­fore the Af­ford­able Care Act,” said Ahn. In fact, prob­lems get­ting enough healthy young peo­ple to sign up for in­sur­ance has al­ready contributed to ris­ing premi­ums. The ad­min­is­tra­tion late last month an­nounced that costs will jump by an av­er­age of 25 per­cent next year. In­di­vid­ual US states al­ready have ex­pe­ri­ence with this dilemma. When Ken­tucky at­tempted in the 1990s to guar­an­tee cov­er­age with­out in­sti­tut­ing an in­di­vid­ual man­date, it saw 43 of 45 in­sur­ance com­pa­nies flee its mar­ket over seven years. Sim­i­lar out­comes oc­curred in New York and New Jersey. Al­ready there are signs that a “Trump ef­fect” is roil­ing the health care mar­ket. In just the day af­ter Trump’s vic­tory, en­roll­ments in the Oba­macare in­di­vid­ual mar­ket­place surged to 100,000, the gov­ern­ment said.

By early next year, providers will have to set­tle on pre­mium rates but they cur­rently do not know whether the pub­lic sub­si­dies that help low-in­come con­sumers will ex­ist by then. Two days af­ter Trump’s vic­tory, Amer­ica’s Health In­sur­ance Plans, an in­dus­try lobby, warned against “sud­den dis­rup­tions” that could jeop­ar­dize “con­tin­u­ous cov­er­age.”

Some in the resur­gent GOP may fear a back­lash. “Clearly, we don’t want to do any harm to peo­ple al­ready in the sys­tem,” Mississippi Repub­li­can Sen­a­tor Roger Wicker told Bloomberg last week. Since Oba­macare took ef­fect, 20 mil­lion peo­ple gained health cov­er­age, push­ing the level of the unin­sured be­low 10 per­cent, an his­toric low. And one sur­vey found more than 80 per­cent of whose who gained cov­er­age are happy with their plans.

Dis­ap­point­ing the base

The Con­gres­sional Bud­get Of­fice es­ti­mated about 22 mil­lion peo­ple would have lost their cov­er­age, with a large share be­ing chil­dren and the poor, had con­gres­sional Repub­li­cans suc­ceeded in re­peal­ing Oba­macare early this year. Trump’s soft­en­ing stance also may cause him prob­lems among sup­port­ers. Michael Can­non, di­rec­tor of health pol­icy stud­ies at the lib­er­tar­ian Cato In­sti­tute and a critic of Oba­macare, warned Trump risks alien­at­ing his most ar­dent sup­port­ers if he fails go through with a full re­peal, in­clud­ing elim­i­nat­ing the ban on deny­ing in­sur­ance to those with pre-ex­ist­ing con­di­tions.

“That’s go­ing to be a big problem not only for Pres­i­dent Trump but also for a lot of con­gres­sional Repub­li­cans,” he told AFP. “Pres­i­dent Trump could be start­ing his ad­min­is­tra­tion by sig­nal­ing that he’s no dif­fer­ent from any­one else.” Rep­re­sen­ta­tives for Trump and for Paul Ryan, the Repub­li­can leader in the House of Rep­re­sen­ta­tives, did not re­spond to re­quests for com­ment.

NEW JERSEY: Pres­i­dent-elect Don­ald Trump lis­tens to ques­tions from the press as he ex­its the club­house af­ter a day of meet­ings at Trump In­ter­na­tional Golf Club, in Bed­min­ster Town­ship, New Jersey.—AFP

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