Analysis | How Trump's Election Could Impact Healthcare In Connecticut

Health policy circles are buzzing with potential policy changes under the second Trump administration. Last time, Trump proposed significant cuts and administrative burdens for Medicaid, which covers 934,043 low-income Connecticut residents. That makes this a very bad time to be considering bringing the failed private Managed Care Organizations (MCOs) back into the program. Other significant disruptions for Connecticut healthcare could include the loss of insurance subsidies, halting Medicare's drug price negotiations but not stopping overpayments to Medicare Advantage plans.

Medicaid could be at risk just because it's not a priority. Extending tax cuts passed in his last term were a frequent promise in Trump campaign speeches this year. Congress may require the President to cover that lost revenue with cuts to the federal budget. Candidate Trump, like Presidential candidates before him, promised not to touch Social Security and Medicare. The next highest cost category is Medicaid, which he didn't promise to protect.

Medicaid is run by states, but with significant federal funds and within guardrails in federal law, which could change. In his first administration, Trump and Congressional leaders proposed to cap per capita spending on the program and block grant Medicaid for states. Under either plan, states would get a fixed amount of federal funding, regardless of the costs. It's estimated that under Republican Medicaid proposals, states would lose at least $110 billion over eight years. Connecticut would be on the hook if the federal reimbursement wasn't enough to meet the need.

Connecticut would face some very grim options to cover those costs. We could lower the costs of the program by cutting the number of people on the program, cutting services, and/or cutting provider payment rates. Other unappealing options include raising taxes or cutting other state services. There are no good scenarios here.

Other healthcare cuts are also looming. The enhanced subsidies for insurance on Access Health CT, our state health insurance exchange, are scheduled to stop at the end of next year. If that is allowed to happen, the Congressional Budget Office (CBO) estimates that four million Americans will become uninsured, joining Connecticut's 205,000 uninsured now. Unfortunately, CBO estimates that it would cost $335 billion over the next decade to continue those subsidies. It's also unclear whether President Trump would continue Medicare's ability to negotiate drug prices. Efforts to scale back overpayments to Medicare Advantage plans are at risk, too.

We can't control what's happening in Washington. But we can choose not to make things worse here in Connecticut. The Governor's plan to bring MCOs back into HUSKY was never a good idea. But Trump's election makes it impossible. The burden of federal Medicaid changes will fall on Connecticut Medicaid members, taxpayers, and providers. Layering on the burden of returning to MCOs would be reckless.