With the 2016 election at its end, we’re faced with the very real question of how the results will impact America’s health care system over the next four years and beyond. First, a little perspective is in order.
Over the last eight years, the Obama administration has passed and progressively implemented the Affordable Care Act (ACA), commonly known as Obamacare. Since 2008, the number of uninsured Americans ranging between the ages of 18 to 64 (adults not eligible for Medicare) has fallen from a peak of 18 percent at the end of 2013 to roughly 11.9 percent in 2016.
The reduction in the number of uninsured has also come with an unexpected consequence. Insurance premiums increased by roughly 7 percent in 2016 and are expected rise as much as 22 percent in 2017. There are many possible explanations, ranging from the requirement to cover patients with preexisting conditions to the rising cost of medical procedures and drugs.
With these issues in mind, we are set to examine how the next few years will handle the Trump presidency and what, if anything, it may mean for your coverage and the nation as a whole.
The Election Results – What They Mean
If you’ve followed the 2016 election, you’ve no doubt noticed the Republican Party has taken control of both legislative bodies as well as the executive seat. With a Republican-controlled Senate and House of Representatives, the party is largely free to write and send most legislation straight to the desk of the president with a simple majority vote.
President-elect Trump will be in charge of signing legislation into law. If the Republican Party works in sync, that means it will be very easy to get things done quickly. There are, naturally, some roadblocks. A minority party can use a filibuster to delay a vote on the Senate grounds, although a three-fifths majority vote can end a filibuster.
Repealing legislation follows a similar path. To repeal a law in its entirety, a majority vote is required, but a three-fifths majority is required to defeat a filibuster. This differs slightly from constitutional amendments, which require a two-thirds majority. There are other strategies to repeal laws, but this remains the standard process.
Additionally, legislation can be ruled unconstitutional by the Supreme Court if it is found to violate any constitutional tenants. A veto by the president is normally one other such roadblock, but President-elect Trump is unlikely to veto his own party’s legislation.
This brings us to another point: President-elect Trump will be nominating new Supreme Court justices throughout his presidency, the first being a replacement for the recently deceased Justice Antonin Scalia. There are also two additional justices who could be nearing retirement: Justice Ruth Bader Ginsburg and Justice Stephen G. Breyer.
Conservative justices are more likely to support Republican legislation, which might increase the likelihood of the Affordable Care Act’s repeal. With that as a very real possibility, the next logical question is predictable: What will fill the void?
President-elect Trump’s Plans
According to Donald Trump’s campaign website, he has a number of plans regarding health reform for his term in office:
- Repeal the Affordable Care Act
- Allow cross state insurance sales
- Tax-deductible health insurance premiums
- Tax-free health savings accounts (HSAs)
- Price transparency
- Relegating more control of Medicaid to states
- Decreasing the difficulty of bringing pharmaceuticals into the market
The first point requires little explanation; his plan is simply to eliminate Obamacare. In his speeches, Trump has discussed replacing Obamacare with other legislation, but the website platform only mentions its repeal, so additional details are not yet available.
Amending laws that prevent health insurance sales from one state to the next may have varying effects. In some cases, local insurance that previously held a monopoly will face competition; it may also mean consolidation of insurance into larger, more powerful corporations.
Modifying the tax code to allow for insurance deductions on taxes may have a larger impact on higher-income families, as the Affordable Care Act already allows lower-income families to deduct their insurance premiums from taxes at the end of the year.
The notion of health savings accounts is nothing new; numerous professions already use a similar system, particularly surgeons and doctors who are faced with high malpractice insurance premiums but low coverage amounts. A tax-free account that can be passed on without suffering the death tax, however, is new.
To some degree, states already have a great deal of control over Medicaid allotments. For instance, while Medicaid is available to low-income individuals in the state of Florida, college students are excluded from eligibility.
It is difficult to determine how foreign competition will affect the cost of pharmaceutical drugs. While it may reduce the cost, it could simultaneously shift wealth out of the United States, similar to how overseas production has decreased the number of American manufacturing jobs.
Despite knowing President-elect Trump’s plans, there is no guarantee any of these ideas will take effect during his term. The president is not a legislator and does not pass laws. It is only his or her job to sign bills into law. The president may advise Congress but cannot actually introduce new legislation.
Roles of the Court
As was mentioned above, one of the president’s jobs is to nominate new Supreme Court justices. That doesn’t mean the president actually appoints anyone to the position. Congress must first confirm the nomination.
Supreme Court justices have a tremendous impact on how the country’s laws are interpreted. Language in the second amendment is one of consistent contention, and its application is determined largely by the court’s ruling.
The Affordable Care Act also faces similar stipulations. In 2015, the Supreme Court ruled that Obamacare did not specifically violate constitutional law. A more conservative court may have ruled otherwise and may do so in the future.
The reverse will also be true should President-elect Trump and Congress succeed in repealing the Affordable Care Act. Should they choose to promote legislation to replace it (as has been a platform mentioned during the numerous 2016 debates), it must also pass Supreme Court approval lest it faces the same judicial repeal Republicans sought during the Obama presidency.
The Continued Balance: 2018
While the Republican Party currently controls the Senate, a lot can change halfway through the Trump presidency. In the year 2018, another Senatorial election could easily change the balance of power in one of the two houses. The Senate alone will have 33 seats up for election, enough to change the majority.
If the Republican Party fails to pass legislation by 2018 or is viewed as having done a poor job by then, it is likely that it will lose seats, and changes to healthcare may be delayed or prevented. Should Obamacare remain in place, premiums may continue to rise as they have, or they may fall as a result in the reduction of unpaid hospital visits (one of the major factors in health costs).
It may be an unsatisfying end, but the truth about 2017 and beyond is only the uncertainty of America’s future in the world of health care. Legislation from the Republican Party regarding health care reform is still unclear. Additionally, there is no way to be sure whether they will successfully repeal Obamacare.
For now, the best course of action we can take as concerned citizens is to pass on our uncertainties to elected representatives. Senators and House Representatives are supposed to act on behalf of their constituents—that means us—but they also require some level of input as a result.
If you are concerned about health care as we move into 2017, write your senator. Explain what you want to happen and what you’re unsure about. Calling your representative’s office may also provide valuable information about what to expect.
With that said, what are you hoping to see happen? Tell us your concerns and expectations in the comments section.