Wednesday was a terrible day in the office. I was a mess. I had been awake most of the night, my worries as dark as the bedroom. Clients called. Clients texted. Everyone, all through the day, wanted to know how this election would affect them. I was too busy to write this update. And I was too concerned about the possible impact to prepare a full report. A friend came in around 5:30. He asked me how I was doing. I told him. I probably did ten minutes on where we were and how worried I was about my clients. He was very patient. Then he asked me, again, how I am. I had completely forgotten that my friend David is totally apolitical. He was asking about my health!
We’ve had a couple of days to watch the president-elect articulate his vision and the current Congressional leaders voice theirs. They are not the same. The future of health insurance will be determined by both the new president and Congress. And the courts may also play a part in our future.
This blog is Health Insurance Issues With Dave. It is not my interest nor place to discuss any part of the election that does not deal with health insurance. And health insurance is our method of compensating medical providers for their products and services. Health insurance is regulated on both the state and federal level, which means that decisions are influenced by finances and the public good. Finances are in black and white. The public good is open to discussion.
The president-elect campaigned on the promise to Repeal and Replace Obamacare (The Patient and Protection and Affordable Care Act). The Republicans who control Congress have promised this for years. On Tuesday the coyote caught the roadrunner.
First, Mr. Trump. As discussed in March, there wasn’t a detailed Trump alternative. We had no idea, prior to the election, what his priorities were or how he would accomplish them. Our closest peek into his thinking came at his Gettysburg speech in late October when he spoke of selling insurance across state lines and of increasing access to Health Savings Accounts, both Republican ideas. This week he expressed his view that the Repeal and Replace would take place simultaneously and that two key provisions of Obamacare – coverage for pre-existing conditions and the ability of children to retain their parents coverage till age 26 – would be continued.
Congress has a different view. Some in Congress have PRIVATELY admitted that Obamacare couldn’t be repealed. Amended? Sure. Changed? You bet. But the idea of repealing the law and blowing up our system, and 20% of our economy, and then eventually replacing the law would be a disaster. Passing repeal bills was safe and easy. There was no danger as long as a Democrat was in the White House to veto the law.
We have had a chance to review the various alternatives. Over the las few years I have covered plans from Governor Scott Walker, Speaker of the House Paul Ryan, and Senator Orrin Hatch. Some have been exercises in ideology and others are closer to marketing projects, the rebranding of Obamacare to a Republican name. You will hear a lot more about this in the coming months.
Let’s quickly hit a couple of the major talking points.
Selling Insurance Across State Lines – I have tackled this a number of times. This is a link to the Kaiser Foundation’s explanation.
Covering Pre-existing Conditions – Everybody loves this, but it doesn’t work unless we have everyone participating. Given the opportunity, lots of healthy people would choose to save their money until they needed coverage. Health insurance is really expensive if only the unhealthy buy it. That means that any law, Obamacare or its replacement, needs to have some form of mandated participation.
Subsidies – The current Tax Credit Subsidy is complicated. There is a lot of room for improvement. Some of the Republican plans will give you a tax credit in 2018 for what you paid in 2017 on insurance. That only works if you can afford the premium in 2017. That eliminates millions of Americans.
Health Savings Accounts – Another great idea if you’ve got disposable income and could us a tax break. Otherwise, no big deal.
Preventive Care – This is really important, especially for children. There is an upfront cost, but long term savings. How preventive care is defined may be changed under the new administration. This has been very contentious.
This has been a very long post and I truly appreciate your patience. There are no simple answers for complex questions. I am very concerned about what the next year holds for us.
I leave you with a thought about a Ferris Wheel. The ride stops when you get to the top. The view is incredible. You are filled with joy. The ride begins to move again and eventually you are at the bottom and forced to leave. The world, even our little world of health insurance, is never as euphoric or bleak as it might seem. We will get through this together.