Campaigns are built on promises and soon to be President Donald Trump promised to come up with “something terrific” to replace the Affordable Care Act.
Campaigning against the ACA is easy. Doing something about it is difficult. If the ACA were repealed, nearly 30 million Americans enrolled in health care marketplaces or covered by Medicaid expansion would have some disruption in coverage or lose it all together. Democrats and Republicans have a hard time agreeing on anything and I’m not going to spend much time sharing what they won’t agree on. Instead, let me share some things I do believe the two parties can come together on.
Like any new process the ACA has its pluses and minuses, there are opportunities for it to be improved and there are opportunities to recognize some of the benefits it has created. It’s safe to say the ACA will change over the course of the next couple of years. I believe both parties could agree on tightening enrollment rules to reduce cost and give insurers more flexibility to sell cheaper plans to young, healthy individuals. I also believe both parties will be motivated to preserve the pre-existing condition exclusion in the health insurance marketplace and to allow individuals to remain on a parent’s plan up to age 26. Creating more incentive for people to maintain continuous coverage from year to year is another option that might find middle ground.
The two sides could also come together on giving states greater flexibility in designing their own coverage system. Slightly more than half of the states have expanded Medicaid and in those states more citizens have access to needed health care services. States like Missouri, that have not expanded Medicaid, may be more willing to do so if they had the ability to expand Medicaid in a manner they believe will work best in their state.
Allowing insurers to sell insurance products across state lines should be an easy compromise. For Republicans opening the marketplace falls in line with their desire to create a more business friendly environment by reducing regulation. For Democrats opening the marketplace could be viewed as a way to increase coverage options and reduce cost.
The stakes are high for Trump when it comes to the ACA. To some extent he’s an outsider to both parties and he will have to walk a fine line to gain support and trust from his party and he has an opportunity to set a tone of cooperation for the next four years with Democrats. We all have a stake in hoping that any type of modification to the ACA whether it be repeal and replace or modification happens soon and doesn’t eliminate coverage for anyone.
Anyone who is currently covered has made a conscious decision that the price and benefit of their coverage is fair, otherwise they would not have opted for the coverage they have. The longer the debate goes over what to do about the ACA the longer other pressing issues are placed on the back burner. Issues like job creation, tax reform, immigration, trade and national security will likely not receive the attention they deserve until a health care deal is reached.
The ACA, or Obamacare, created President Obama’s legacy. What happens next with the ACA, or Obamacare, could define President Trump’s legacy as well.