Fixing Health Care, Preserving What’s Good

As furious speculation swirls, here's what 'repeal and replace' actually means

With Donald Trump’s promise to repeal and replace Obamacare on many Americans’ minds, there are numerous questions about how the health care system will work in the very near future. There are equally as many, if not more, outlandish speculations.

Donald Trump was elected a week ago and doesn’t assume office for two more months. Much of what will get changed and how is yet unknown. Yet the mainstream media has been quick to undermine Trump and dispirit his supporters, as the media did during the entire campaign as well. NBC News shouted, “Repeal Obamacare? Maybe Not, Says Trump.”

Repeal and replace does not mean scrapping the entire health care insurance system and starting from scratch.

Take what you hear and read with a big grain of salt. Given past experience with government reform, it will likely not be as drastic nor as draconian as some hope for and others fear.

Repeal and replace does not mean scrapping the entire health care insurance system and starting from scratch with something new. Obamacare itself did not replace what existed previously, but instead added or modified.

Trump’s campaign website indicates that health savings accounts and patient-centered choice and value are two of his core policy proposals. Coverage for pre-existing conditions will likely remain in place.

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Related: A Post-Obamacare World: How Patient’s Will Benefit

Allowing adult children up to age 26 to remain on their parents’ policies is also part of Trump’s plan. With about a third of millennials still living at home with their parents — many of them unemployed or underemployed — why not let them stay on their parents’ plan with the insurance premium reflecting the added coverage? Parents pay the premiums, of course, not the government.

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Trump also proposes high risk pools for sicker individuals and allowing people to purchase insurance across state lines, increasing competition and lowering costs. Finally, he recommends allowing states to design their own programs as a testing laboratory. (Colorado and Vermont have both attempted — but did not implement — a single-payer system.) Innovation at the state level makes sense with further nationwide implementation if successful.

Trump cannot by himself repeal or replace Obamacare. By constitutional necessity this will have to come from Congress. And it has, by the way — there have been 60 attempts by Congress to repeal Obamacare, stymied by an Obama veto. With a new guy in the White House and a Republican-controlled Congress, the veto threat is gone.

Related: 5 Things to Do as Obamacare Collapses

There is still the obstacle of a Democrat filibuster, although there is the trick of using budget reconciliation to pass legislation with only 50 rather than 60 votes. Democrats used this maneuver to pass Obamacare. in an ironic twist of fate, it might be used to repeal it.

The reality is that Obamacare is unsustainable. It’s been collapsing under its own weight of rising premiums with fewer insurance companies willing to participate. A rescue is needed before the existing scheme implodes.

And Trump, of course, is not the only one who has said this. Republicans in Congress have long maintained this. As speaker of the House Paul Ryan said recently on CNN, “Obamacare is failing. It must be replaced. We’re going to do that. We’re excited about it … We can fix what is broken in health care without breaking what is working in health care.”

Brian C. Joondeph, MD, MPS, is a Denver-based physician and writer. 

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