More than 290,000 Missourians have health coverage through the Affordable Care Act or Obamacare. In the months leading up to the recent presidential election, the ACA was a sticking point for both sides. President elect Donald Trump repeatedly called the ACA a disaster and promised to repeal and replace the law.
Repeal and replace makes for a good platform but is easier said than done.
President elect Trump’s stance on the ACA has changed a bit since the election. His position has softened and he’s said publicly that he’s willing to retain certain aspects of the law and replace or eliminate specific portions. Specifically, Trump has said that he hopes to keep protections for people with pre-existing conditions and to allow children to stay on their parents plans until their mid-twenties.
Republican members of Congress have been trying to repeal the law for years but they haven’t had the votes to do so, until now. Republicans hold majorities in Congress and there will be a Republican President in January. It will be interesting to see if repeal continues to be a priority or if prior discussions of repeal were posturing and rhetoric.
A complete repeal, without a replacement plan, would have severe implications on the health care delivery system and may cause the system to unravel all together. I don’t foresee that happening. Instead I would suspect that bits and pieces of the law are changed. Trump is pro business so opportunities for insurance providers to sell across state lines may come into play. An increased emphasis on health savings accounts might also be a priority.
I would suspect that Medicaid reform will be a priority at both the state and national level. One way Medicaid could be reformed would be to switch to a Medicaid block grant system. Trump hinted at using Medicaid block grants during his campaign. A block grant system would allow for the federal government to disperse Medicaid funding to states and then states could create eligibility requirements.
Campaigns are full of promises and campaign promises, more than any other, are meant to be broken. The ACA is the law of the land and the health care system has adjusted and is functioning according to rules. A total repeal will be difficult and without a suitable replacement it could be disastrous.