What Trump can learn from Obama’s rough ride on health care

‘If you like your health care plan, you can keep it’

Kuwait Times - - HEALTH & SCIENCE -

Pres­i­dent Barack Obama took on the prob­lems of a lack of ac­cess to health care and high cost, but he and Democrats paid a po­lit­i­cal price. Pres­i­dent-elect Don­ald Trump has promised to undo much of what Obama put in place, and pledged to make the sys­tem bet­ter. Although Trump is lack­ing in specifics, he seems to want to make costs his pri­or­ity. States, in­sur­ers, busi­nesses, and in­di­vid­u­als would get more lee­way to sort out ac­cess. Health care keenly re­flects the coun­try’s deep po­lit­i­cal di­vide. A look at some lessons Trump might learn from Obama’s rough ride:

The per­ils of prom­ises

Obama promised that “if you like your health care plan, you can keep it.” But then sev­eral mil­lion peo­ple were threat­ened with the loss of poli­cies that didn’t con­form to his over­haul. Obama said pre­mi­ums would come down, too. Trump hasn’t made such spe­cific prom­ises, yet it may al­ready be too late for him. In the cam­paign, Trump made it sound like re­plac­ing the law would be quick and easy, and peo­ple would be widely sat­is­fied with the re­sults.

Con­sider his idea for al­low­ing in­sur­ers to sell poli­cies across state lines. “Get rid of the ar­ti­fi­cial lines and you will have your­self great plans,” Trump said. That ig­nores prac­ti­cal is­sues such as whether an in­surer in Hous­ton can set up a vi­able net­work of doc­tors in New York. “There are no easy so­lu­tions in health care,” said Jim Capretta, a health pol­icy ex­pert with the busi­ness-ori­ented Amer­i­can En­ter­prise In­sti­tute. “What­ever is done will nec­es­sar­ily in­volve some trade-offs, and win­ners and losers. There are po­lit­i­cal risks as­so­ci­ated with ev­ery kind of pol­icy pro­posal.”

Medi­care and Med­i­caid

As a can­di­date in 2008, then-Sen. Obama pro­posed re­quir­ing par­ents to get health in­sur­ance for their chil­dren, one of sev­eral steps to move to­ward cov­er­age for all. As pres­i­dent, he em­braced a broader “in­di­vid­ual man­date” re­quir­ing most peo­ple to be cov­ered. En­forced with fines from the IRS, it’s been un­pop­u­lar from the start. Sep­a­rately, Obama and a Demo­cratic-led Congress fi­nanced part of the cov­er­age ex­pan­sion in the Af­ford­able Care Act with cuts in Medi­care pay­ments to ser­vice providers. That was an un­wel­come sur­prise to older peo­ple. Even if Medi­care cuts im­proved the pro­gram’s bal­ance sheet, older vot­ers helped de­liver the House to Repub­li­cans in 2010, a few months af­ter Obama signed the over­haul.

Trump has promised not to cut Medi­care, but Repub­li­can lead­ers in Congress want to re­vamp the pro­gram to pro­vide fu­ture re­tirees with a fixed amount to pur­chase pri­vate in­sur­ance. Will Trump go along? Trump ini­tially also said he wouldn’t cut Med­i­caid, the health care pro­gram for low-in­come peo­ple. Dur­ing the cam­paign, though, his views shifted to back­ing a “block grant” that would limit fed­eral money to states and could re­sult in big cuts. Medi­care and Med­i­caid have been around for more than 50 years and are po­lit­i­cally pop­u­lar. Most peo­ple, in­clud­ing Repub­li­cans, don’t equate the pro­grams with the health law. So Trump could be left ex­posed.

Go­ing it alone

Democrats passed the 2010 law over solid GOP op­po­si­tion. Pro­gres­sives blamed Repub­li­can ob­sti­nacy and said the over­haul con­tained many pro­vi­sions with a cen­trist, even Repub­li­can, pedi­gree. But the lack of bi­par­ti­san sup­port stoked years of op­po­si­tion. Trump’s abil­ity to win over some Democrats will de­ter­mine whether his ideas are re­mem­bered as a fleet­ing lurch to the po­lit­i­cal right or a last­ing course cor­rec­tion. At the mo­ment, it’s hard to de­tect any glim­mer of bi­par­ti­san­ship. “If Pres­i­dent Trump suc­ceeds in get­ting the ACA re­pealed, he and the Repub­li­cans will ‘own’ Amer­ica’s health care sys- tem,” said Ron Pol­lack of Fam­i­lies USA, a lead­ing ad­vo­cate for Obama’s law. “As tens of mil­lions of peo­ple lose cov­er­age, the blame will go squarely onto the shoul­ders of those who en­gi­neered the re­peal.”

Peo­ple live here

When Obama signed the mea­sure into law, Democrats hailed it as the ful­fill­ment of his­toric as­pi­ra­tions to close the last ma­jor hole in the na­tion’s so­cial safety net. If Trump gets to sign “re­peal and re­place” leg­is­la­tion, the rhetoric will be about get­ting govern­ment off peo­ple’s backs and giv­ing con­sumers the op­tions they re­ally needed.

How will the re­al­ity mea­sure up?

Obama’s law has been a life­line for many peo­ple who pre­vi­ously could not get cov­er­age. For others it brought un­wanted le­gal obli­ga­tions and expenses that bur­dened house­hold bud­gets.

The law did not hold back the trend of ris­ing out-of-pocket costs for those with em­ployer cov­er­age. Peo­ple worry about the over­all af­ford­abil­ity of their health care, said Larry Le­vitt of the non­par­ti­san Kaiser Fam­ily Foun­da­tion. Con­sumers have got­ten savvy that out-of-pocket costs, which come on top of pre­mi­ums, erode the value of their in­sur­ance card.

“Repub­li­cans may be tempted to push in­sur­ance pre­mi­ums down by al­low­ing in­sur­ers to of­fer skimpier cov­er­age with fewer ben­e­fits and higher de­ductibles,” he said. “That’s not likely to sat­isfy con­sumers in the end.”—AP

PHOENIX: In this June 17, 2013, file photo, Ari­zona Gov Jan Brewer signs the Med­i­caid ex­pan­sion law in Phoenix.

PHOENIX: In this June 17, 2013, file photo, Ari­zona Gov Jan Brewer signs the Med­i­caid ex­pan­sion law in Phoenix.

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