The emphasis of this post is literally on what we know today, because who knows what tomorrow’s news cycle has in store for us. You have likely come across some of these stories. Still, let’s recap.
President Elect Donald Trump says he wants “insurance for everybody”
In an interview over the weekend, President Elect Trump declared that he is almost done with a replacement plan for Obamacare that has the goal of “insurance for everybody.” As we know, the devil is in the details here. Jonathan Cohn’s analysis at the Huffington Post suggests three potential explanations for this declaration that seem persuasive:
- Trump has gone rogue, and his plan will have more in common with proposals by Senator Bernie Sanders (D-VT) rather than Speaker Paul Ryan (R-WI).
- Trump is using language to mislead the public and allay fears about losing health insurance, when in fact the replacement plan will be similar to existing Republican proposals, and would not actually provide insurance for everybody.
- Trump has no idea what he is talking about.
We have heard Republicans touting their goal of “universal access,” which has a bit of a different spin than “insurance for everybody” (AKA, universal coverage). In other words, Republicans are being very clear with their language that people would not have to buy insurance if they don’t want to (i.e., get rid of Obamacare’s individual mandate) but instead it would be available should people choose to purchase it. It is not clear if or how Trump’s recent declaration of “insurance for everybody” aligns with these Republican talking points.
Given this apparent contradiction, the third explanation may have some merit. Sean Spicer, the soon to be White House Press Secretary, followed up to clarify Trump’s comments, explaining that the goal of their plan is to “get insurance for everybody through marketplace solutions, through bringing costs down, through negotiating with pharmaceutical companies, allowing competition over state lines.” This sounds a bit more like the Republican talking points.
Notably, both Trump and Spicer referenced an expanded role for government, enabling government to negotiate prices directly with pharmaceutical companies for Medicare. This is similar to what we heard from Trump on the campaign trail, yet it is in conflict with historical opposition from Republicans on this issue.
While Trump suggests that his Obamacare replacement plan is close to finished, he said he will wait to reveal his plan until after Representative Tom Price, his pick for Secretary of Health and Human Services, is confirmed. So, we will have to wait and see what “insurance for everybody” actually means to President Elect Trump.
Tom Price’s confirmation hearings begin tomorrow
Representative Tom Price will begin confirmation hearings tomorrow with the Senate Committee on Health, Education, Labor, and Pensions (HELP) (live stream here starting at 10am). Importantly, the HELP Committee and the Senate Finance Committee have joint jurisdiction over Price, but the vote to advance his nomination to the floor of the Senate rests with the Finance committee, which is not scheduled until Tuesday, January 24th (live stream here). In case you are wondering what may or may not be discussed at the hearings, here are a couple ideas.
Apparently, Representative Price and the Trump Administration do not want Price’s replacement plan for Obamacare to be a significant part of the conversation at the hearings. While we know that Representative Price’s plan proposed while in Congress was more restrictive that Speaker Paul Ryan’s A Better Way, we are still lacking details on a unified replacement plan.
Perhaps more important, there are some emerging ethical concerns about Price’s behavior while in Congress. A recent CNN report suggested that Price purchased shares in a medical device company, Zimmer Biomet. Less than a week later, he proposed legislation that would delay implementation of regulations that would have a negative financial impact on the company. Furthermore, after the introduction of this bill, there is evidence that the company then donated to Price’s campaign for re-election through their political action committee. This adds to existing reports from the Wall Street Journal which suggested that Price had traded health care stocks worth more than $300,000 throughout a four-year period at the same time that he sponsored or supported legislation that could have impacted the value of those stocks. These allegations have Senate Democrats raising concerns about potential insider trading and calling for an investigation and requesting that his confirmation hearing be delayed. No doubt, these concerns will continue to be raised throughout the confirmation process.
Analysis from the Congressional Budget Office
You have likely heard the news: CBO Predicts Obamacare Repeal Could Leave Millions Without Insurance. The report released today by the nonpartisan Congressional Budget Office (CBO) was tasked with a specific analysis. What would happen if two key provisions of the ACA were repealed: (1) the individual mandate and employer penalties for not providing coverage to employees, and (2) the insurance subsidies (i.e., tax credits) to help people afford to buy health insurance in the health insurance exchanges? And even more important, what would happen if at the same time you kept several of the private insurance reforms in place (i.e., requiring certain levels of benefits and coverage, not charging more for people with pre-existing conditions, and maintaining modified community rating). Since we do not have current legislation, these analyses are based on The Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 (HR 3762), the bill that was sent to President Obama’s desk last year to repeal key provisions of the ACA. Some of the highlights from this analysis include:
- COVERAGE: In year one following enactment, 18 million more people would become uninsured. By 2026, this number would increase to 32 million, relative to what we would expect if the ACA were to remain in place.
- COST: Premiums in the non-group market (i.e., people who currently purchase health insurance in the health insurance exchange rather than through an employer) would be 50 percent higher in the year following the elimination of health insurance subsidies. By 2026, premiums would be twice what we would expect with the current law.
For a more detailed breakdown on the analysis, check out Timothy Jost’s summary on the Health Affairs Blog.
Now, these are certainly some grim statistics. However, it is worth pointing out that these estimates do not fully account for whatever would be put in place after the repeal. Still, given the Republican focus on “universal access” without the individual mandate and also vowing to ensure protections in the private insurance markets, these analyses may not be so far afield.