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What would health care look like under Trump?

Nathan Baker • Updated Nov 14, 2016 at 8:55 AM

With President-elect Donald Trump two months from inauguration, area health professionals and policy experts wonder what the Republican-controlled White House and Congress will mean for the health care industry.

Speaking two weeks ago at a campaign rally in Philadelphia, Trump repeated a campaign promise and central platform issue that ultimately helped propel him to victory. “When we win on Nov. 8 and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare,” he told a cheering crowd.

After a visit Thursday with President Barack Obama, for whom the Affordable Care Act is commonly named, the incoming Republican outlined a few parts of the six-year-old health care reform law he would keep.

Trump told the Wall Street Journal he believed provisions preventing insurers from refusing coverage for pre-existing conditions and allowing children to stay on their parents’ health plans until age 26 should stay, while other market-minded changes were enacted

In policy goals set on his campaign website, the new executive aims to remove the individual mandate requiring Americans to purchase health insurance, make grants to state governments to be used to provide lower-income residents with coverage — as opposed to requiring states’ expanded Medicaid programs to cover individuals with incomes up to 138 percent of the poverty line — give tax breaks to allow people to purchase insurance and allow insurance companies to sell policies across state lines.

Mountain States Health Alliance CEO Alan Levine, who previously served as Louisiana’s Department of Health Secretary and policy advisor to Republican Gov. Bobby Jindal and deputy chief of staff and senior health policy advisor under Florida Gov. Jeb Bush, also a Republican, said it’s “a virtual certainty” that Congress will pass legislation to repeal and replace the Affordable Care Act, and that Trump will sign it into law.

“It’s a pretty complex statute that’s now supplemented by thousands of pages of rules,” Levine said. “It will be interesting to see how the president chooses to go about repealing it.”

Trump could, for instance, immediately upon taking office stop enforcing health care law guidances put in place by Obama’s administration.

Providing block grant funding to the states could improve Mountain States’ revenue outlook, Levine said, because Tennessee state legislators, up to now unwilling to accept federal funding and requirements for Medicaid expansion, may be convinced by the additional leeway promised in Trump’s grant program.

“I think the state legislatures will be willing to give (expansion) a fresh look when they believe there’s more flexibility and more marketplace freedom,” he said. ... “How that’s done, what dollars are attached to it, those are details that would be really good to know in terms of trying to respond to the changes.”

U.S. Rep. Phil Roe, a Republican re-elected last week to serve Tennessee’s 1st District, said he intends to use his influence on the House Education and Workforce Committee, where he chairs the Subcommittee on Health, Employment, Labor and Pensions, to interject free-market principles into the country’s health care system.

“What actually happened with Obamacare is, instead of creating more competition, it wiped it out,” Roe said. “In Kansas, every county has only one choice (on the federal health insurance marketplace), in Tennessee, we have 95 counties, 70 have only one choice, in North Carolina, instead of creating more competition, it created less.”

Roe, who sat twice on a Republican study group to propose a legislative alternative to the ACA, said allowing Americans to purchase insurance across state lines would help reduce costs to consumers. He also would like to see tax breaks for lower-income residents to buy insurance, block grants to states and high-risk pools to keep those with more expensive, chronic conditions from increasing prices for relatively healthy Americans.

A transitional bridge for those currently covered by federal marketplace plans would make the switch easier when the new health care reform is enacted, a process Roe said could take 18 months or more.

“What you’re going to hear from the Democrats, they’re going to scream and cry and say we’re taking health care away from 20 million people, and we’re creating a situation where people can’t afford to buy care,” the congressman said. “Premiums have gone from $500 per month to $1,500 per month in the last two years, some states have seen 100 percent increases this year. It’s already a situation where people can’t afford it.”

Tracy Pate, lead navigator and outreach coordinator for Appalachian Project Access, a nonprofit created in-part to help people find insurance coverage through the online marketplace, said a straight repeal of the law without new provisions would be catastrophic for the millions who purchased coverage for the first time because of it.

“I’m sure there will be changes to the Affordable Care Act — there needs to be changes to it,” Pate said. “But if you look at some of the things it has done, it has helped 20 million people gain coverage, including me, it’s helped 130 million with pre-existing conditions gain access, insurance companies can’t charge women more than men anymore, and people 26 and younger can remain on their parents’ plans.”

Instead of repealing, Pate said legislators should cap health insurance costs for consumers.

Now two years into a three-year grant, she said Project Access will remain in the area for at least one more year, providing those who need it help finding health care.

“We’re here, and we’re still helping people,” she said. “We’re going to be here for at least one more year.”

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