“Since March of 2010, the American people have had to suffer under the incredible economic burden of the Affordable Care Act—Obamacare,” writes President-elect Donald Trump on his website. House Speaker Paul Ryan recently said repealing the Affordable Care Act will be the GOP-led Congress’ first order of business.
Clearly, Republicans are motivated to roll back President Obama’s landmark, legacy healthcare law. And they have a plan.
The foundation of Obamacare dates back to policy suggestions put forth in the 1990s. It emanated from academics at Dartmouth College, specifically, an economist there named Elliott Fisher. This group was convinced (then and now), that the problem with the U.S. healthcare system is overutilization.
“That’s true sometimes,” says Hedgeye Healthcare Policy analyst Emily Evans in the video above. “But there’s also a lot of underutilization of the system. Like when people have adrenal disease because they have hypertension, and have to go to the hospital because their hypertension wasn’t managed very well and they underutilized the system.”
In other words, Obamacare is flawed. The Republicans want to change it.
“You will hear that the Republicans don’t have a replacement, they don’t have an idea and they don’t have a plan,” says Evans. “It’s an unfair thing to say. Now, do they have actual written legislation? No. But nobody does until you’re actually trying to pass the bill. But they definitely have a plan.”
What will undoubtedly be part of any GOP replacement legislation is the need for more market forces and the incorporation of state goals into any changes, Evans says.
Here are the three principles Evans says will be at the top of any Obamacare replacement agenda:
- Move Medicaid To Per Capita/Block Program – Designed to slow rate of growth and bring greater certainty to state budgets; would most likely result in focus on chronic care, mental health and substance abuse; relies on state innovation
- Consumer-Driven Individual & Small Group – Create pass through refundable credits to states for purchase of insurance anywhere in individual and small group plan; increase portability through expanded use of HSAs, FSAs, HRAs; increase availability of insurers
- Provide Protections (especially to Vulnerable Populations) – Protections from pre-existing condition exclusions for continuous coverage; exclusions, when applied, must relate to a diagnosed or treated condition; dependents remain on parent’s health care
For more, read Evans’ piece “What Trump’s Win Means For Obamacare.”