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Feb 15 2017
'Obamacare,' 'Trumpcare' and your health

In thinking about the future of healthcare, cutting through the rhetoric from Washington these days is like piloting the SS Badger Car Ferry through a deep October fog on Lake Michigan: there’s a long way to go, not a lot of waypoints, and some rough seas ahead. Nevertheless, the journey continues!

Cutting through the fog, here is what we know so far.

First, is Obamacare (Affordable Care Act) a “disaster”? Well, between the exchanges and expanded Medicaid programs, nearly 20 million Americans now have insurance, pre-existing health conditions don’t disqualify you from being insured, and children younger than 26 can now be carried on parents’ insurance, which is vital for so many millennials today.

The act has many major flaws that need attention, but these gains are very real. I know several people for whom the exchanges have literally been a lifeline.

On the other hand, the insurance market for the exchanges is on the verge of collapse, largely as a result of uncertainty from the “repeal and replace” rhetoric from the new administration. In Wisconsin, 240,000 residents are insured through the exchange.

A recent Associated Press poll indicates 52 percent of Americans “disagree with Trump (about repeal and replace) and want to keep or improve Obamacare. Very few want to keep the law as it currently is, however there are many elements that appear to be popular, and there is support for retaining those provisions in any replacement legislation.”

The terms “repeal and repair” and “this will be a process” are increasingly being used by Republican leadership, a most welcome return to the sort of thoughtful and responsible governance that is needed to improve — and not worsen — the situation.

Here’s what we know about the key components of proposed "Trumpcare" legislation today. Importantly, the Republicans will indeed own the legislation and experience the greater challenge of advocating for positive change compared to criticizing from the sidelines.

Federal control over the program will increasingly shift to the states, and the exchange programs will be either privatized or controlled by individual states.

Most pre-existing conditions and other coverage reforms of Obamacare will be retained, but federally-mandated minimum benefits will likely be delegated to the states to determine.

Mandated health insurance coverage will be replaced by some form of market or tax incentives.

Exchange premiums will remain community-rated and will continue to be age-based with a system of tax credits being used to replace Obamacare’s premium subsidies.

Health Savings Accounts will be heavily promoted, but not subsidized, to pay for deductibles and out-of-pocket expenses.

The bottom line: Trumpcare will be an unprecedented shift of financial risk from the federal government to individual states, and in turn, to each person who isn’t insured by an employer. This will significantly impact how much of the gain from Obamacare will be maintained and whether Trumpcare will help improve the health of Americans and sustain a viable health care system.

Mark Herzog, is the president and CEO at Holy Family Memorial.   


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