Trump Said What About the ACA?

By John Hilton

President-elect Donald J. Trump shook things up Sunday by telling The Washington Post he will produce a health “insurance for all” plan to replace the Affordable Care Act.

This is a curious statement because it seems so improbable given the market realities and the health insurance paradigm. Market stability would seem to require an individual mandate to purchase health insurance – with accompanying subsidies -- or government price controls.

Republicans who control Congress have been railing against these very ideas for seven years. It’s not likely that House Speaker Paul Ryan or Senate Majority Leader Mitch McConnell has any interest in any government-dependent compromise plan.

Maybe “insurance for all” means the opportunity to buy insurance? I have a feeling that semantics will determine the real meaning of Trump’s comments.

Then again, the president-elect left little wriggle room with this comment: “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

As the Post put it, “Donald Trump just emphatically promised universal health coverage. That’s an absolutely gigantic promise, and it’s one that Republicans have no intention of keeping.”

Trump’s comments are just the latest sensational development on the ACA issue. Let’s hit the reset button and figure out where with are with Obamacare as Trump and his congressional allies work on repeal and replace.

I turn to the Internet of experts for the latest:

• That WaPo opinion piece nicely lays out the PR challenges Republican leaders face in navigating the delicate repeal and replace quandary.

• The American Enterprise Institute, a conservative think tank, calls for a
“gradual transition” away from the ACA, while allowing everyone who received insurance via the exchanges to keep it indefinitely. The gradual shift will “stabilize the marketplace,” AEI argues in an op-ed.

• Professor J.B. Silvers, a former health insurance CEO, explains how the instability introduced to the ACA marketplace will cause insurers to flee. The road to replace could be long and difficult to keep insurers on board, he argues.

• Sarah Kliff at Vox wonders why Trump didn’t give more details on his plan if it’s, as he said, nearly done. Absent those details, she reminds readers that Trump’s primary campaign health care plan did not cover everyone. In fact, TrumpCare would leave 21 million additional people without insurance.

• Meanwhile, Republican governors are not so sure that the ACA is that bad. Millions who gained coverage through Medicaid expansion potentially could lose coverage. GOP governors don’t want that to happen. Politico has the story.

InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected].