After an election season that largely ignored policy in favor of baseless rhetoric, President-elect Donald Trump put forth several policy plans for his administration. His First 100 Days are a collection of policies with aims ranging from “cleaning up Washington” to trade protectionism to toughening on crime. The notorious “wall” is even included amongst the First 100 Days Plan, complete with promises of reimbursement from Mexico. While the feasibility of these plans might be questionable, many of them are likely to become new American realities over the course of the next four years, especially given the Republican majority within both the House and Senate.
One of the cornerstones of Trump’s domestic policy lies in his proposed multilateral demolition of our current healthcare system. This platform begins with the total repeal of the Affordable Care Act, strongly condemning Obamacare policies. In almost hyperbolic terms, it targets both the law and President Obama himself.“…the American people have had to suffer under the incredible economic burden of the Affordable Care Act—Obamacare,” Trump writes on his website. “This legislation, passed by totally partisan votes in the House and Senate and signed into law by the most divisive and partisan President in American history… has raised the economic uncertainty of every single person residing in this country.”
This absolute vilification of Affordable Care Act systems is used as a precursor to Trump’s proposed “free-market solutions.” After vowing to ask Congress to repeal Obamacare on day one, Trump goes on to vaguely comment on his ideal healthcare system through sentence fragments that lack grammatical structure and oxford commas. He lays out a list of seven points, predicated on permission for insurance companies to sell plans across state lines, in an effort to increase competition. Additionally, the plan calls for individual insurance plans to be considered tax deductible and for the implementation of Health Savings Accounts. HSAs are almost like healthcare retirement plans- they allow individuals the option to invest funds in a tax-free account that could be used on any health-related expenditures.
Trump proposes a requirement of price transparency from all health-related institutions, including hospitals, clinics, and private practices. Notably, his plan includes an end to federal Medicaid funding for states, representing a real dismantling of the American welfare state. An end to federal funding, says Trump, will force the states to efficiently provide care for all of their citizens. Finally, President-elect Trump calls on Congress to denounce the special interests embodied in Big Pharmaceutical lobbyists and lower barriers-to-entry in the drug market. More options in the market, including options from overseas companies, would lower the costs of lifesaving medicines according to the policy plan.
These seven policies proposals are perhaps abstract in nature, but it is important to understand their repercussions. Not all of the proposed items are bad, not all of them are feasible, and quite frankly, not all of them demonstrate a full comprehension of American health institutions.
First, what would it mean to dismantle Obamacare? The Affordable Care Act has provided health insurance coverage to over 20 million Americans. Repealing the ACA would mean withdrawing the plans of all of these 20 million, and raising the uninsured rate across the country. A retraction of the ACA would also entail permission for private insurance companies to deny clients with pre-existing conditions, as well as to charge higher premiums for women based on their reproductive needs. In this scenario, the insured become uninsured, and the sick get sicker. The 20 million people enrolled in Obamacare insurance policies are generally unable to afford insurance without subsidies. Yet many of these people are incredibly ill and in need of lifesaving medical treatment. If these people lacked access to insurance, and their health problems progressed to emergency circumstances, they would end up in the E.R. being treated for dangerous ailments. Doctors do not turn away patients in the emergency room, and would inevitably treat these uninsured patients, who, upon receiving the bill, would have no means of paying. The cost of their operations and treatments is, in turn, absorbed by the hospital through raising the overall prices of general care. In sum, leaving people uninsured raises healthcare prices for everyone.
In addition to raising overall prices, the Trump plan relies on an assumption that people will invest in their own insurance. Health Savings Accounts may sound nice, and it’s certainly appealing to give people free will over their financial decisions. But when it comes down to it, people inherently aren’t that proactive, and when faced with the choice to invest in their own health, those most vulnerable to illness often do not, or cannot based on financial constraints. Reverting to an individually-directed system while taking away the safety net of Medicaid funding is incredibly dangerous- not just for sick people, but for healthcare costs across the country.
The Trump Healthcare Plan ends by fighting for several other policy points as means to a better health system. Trump cites data that “illegal immigrants” costs Americans about $11 billion annually. Trump does not include the source related to this figure, but it is certainly wrong. The Center for Immigration Studies estimates that undocumented immigrants represent a financial burden upon the healthcare system of about $4.3 billion, which is overwhelmingly offset by the economic output and consumer revenue that they add to the American GDP.
With the implementation of these largely misguided policies, we can expect the uninsured rate to go up, and for the prices of overall care to increase. Even if Trump is successful in pushing Congress to stand up to pharmaceutical interests, millions of Americans will be left unable to afford lifesaving treatment, let alone basic medical care. In coming months, Americans most affected by Trump healthcare legislation– women, the chronically ill, and the poor– may need to seek backup plans in attaining their basic right to health.