Healthcare Reform: Falling Backward?

Although healthcare reform was not a dominant issue in the presidential campaign, it is now front and center with significant changes or a full repeal of Obamacare looming. What is known about President-elect Trump’s healthcare proposal and how can we counsel patients who have questions about their coverage?

President-elect Trump’s proposal draws significantly from House Speaker Ryan’s “A Better Way” plan.  

The main tenets are:

1.     Repeal Obamacare

2.     Allow individuals to deduct the full amount of premiums from individual plans from their federal taxes

3.     Provide block grants to finance state Medicaid programs

4.     Allow insurers to sell insurance across state lines.

5.     Expand Health Savings Accounts coupled with High Deductible Heath Insurance Policies

Can Obamacare be repealed?

A full repeal would require a supermajority in the Senate to pass (>60), so unlikely. But several consequential provisions can be eliminated through a special budgetary process called reconciliation that could weaken the bill significantly. Any changes signed in 2017 would not take effect until 2017 or 2018.

Do HSAs work?

Although the number of people in the US with HSAs has increased to 20 million, there is a paucity of evidence that they can decrease the healthcare cost curve or improve quality measures. More research is needed to evaluate if these plans can serve vulnerable populations, specifically low-income populations and the chronically ill.

The main concern is that we not reverse the positive gains Obamacare has realized including increasing access to health insurance for 16 million people and eliminating pre-existing conditions as a reason to deny health insurance. There is still so much work left to accomplish the Triple Aim in the US healthcare system, let’s not go backwards.


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Warm Regards,

Melissa Stiles, MD

“Autumn asks that we prepare for the future —that we be wise in the ways of garnering and keeping. But it also asks that we learn to let go—to acknowledge the beauty of sparseness.”

 Bonaro W. Overstreet