Published by Anjalee Khemlani in NJBIZ
Donald Trump and his fellow 2016 Republican candidates ran on the platform of repealing the Affordable Care Act, also known as Obamacare, and replacing it with cross-state-border health insurance options (rather than strictly state-by-state market exchanges), as well as increasing tax-deductible premiums and health savings accounts.
However, many experts are confident that neither the Executive nor the Legislative branch will entirely repeal the ACA. Here’s what they had to say:
Trump administration and Congress handling health care
Ray Castro, health policy expert with New Jersey Policy Perspective: “I think that (Trump is) going to punt to Congress a lot of this stuff. He’s not going to want to be responsible for cutting assistance to 20 million people. He’s a manager type, so he’ll delegate and tell Congress to figure out a way of doing this. So, I’m going to be curious about what Congress is doing. I’m not as concerned about him. Hard to imagine they are going to willy-nilly eliminate (the ACA) because (those insured under it) are their constituents, too.”
Linda Schwimmer, president of the NJ Health Care Quality Institute: “They’ll be hearing from all their constituents who previously were shut out of insurance coverage and having it literally change or save their lives. So, I think they’ll create a ‘state-driven’ strategy where they leave it to each state to decide whether or not they want to stay in and adopt through state law an ACA type of model or not — similar to the decision on whether or not to expand Medicaid. The Trump campaign has not put out a detailed plan for health care and health insurance, but hopefully the transition team will be working on that. The last eight years have been the most exciting time in health care, with a focused effort on quality improvement, patient engagement and cost reduction. We can’t go backwards on those goals. We’ll have to figure out how the new administration can achieve those goals while keeping their campaign promises. It will be interesting. “
Mark Manigan, attorney with Brach Eichler: “With Trump’s victory, along with the Republican Party maintaining its majorities in the Senate and the House, the likelihood of Obamacare being materially altered, if not repealed, is substantial. To the extent Trump is able to enact the key components of his plan — (Health Savings Accounts), the ability to purchase insurance across state lines and block grants to states on Medicaid — the proof will be in the pudding as to whether there is a net change in the number of insured nationwide and in the New Jersey area.
ACA: Repeal or restructure?
Adam Solander, a health attorney with EBG in Washington, D.C.: “I don’t think when this document was written there was a feeling that both houses of Congress and the president would be in Republican control. I’m pretty confident a repeal is not going to happen. But there will be major changes to the ACA. It’s hard to tell what policy (will be affected) from the election. It was less focused on policy and more focused on personal traits.” The “employer wish list” of repealed mandates and general repeal of taxes associated with the ACA is assured.
Poonam Alaigh, a former New Jersey health commissioner: The repeal of taxes and systematic weakening of the “key pillars” of the ACA will cause the program to collapse on itself. “If they eliminate all the taxes that were imposed to be able to run the ACA — like the taxes on the insurers, the medical device companies and also the 0.9 percent that those of us got taxed with that are making more than $200,000 individually or $250,000 as a married couple. If he repeals those taxes, there is no budget to support the Affordable Care Act.”
What happens to 20 million insured under the ACA?
Atlantic Health CEO Brian Gragnolati: “The question becomes ‘How do you focus on coverage and not repealing the things that people have responded to that came out of (or were inspired by) the ACA?’ (Trump) said he’s not going to allow people to die in the streets without access to health care. We are doing better at that than before.You can see that with the charity care going down in the state, as an example, because Gov. (Chris) Christie, as a Republican governor, had the courage to expand Medicaid.”
Effect on New Jersey and the state budget
Schwimmer: “If the ACA were to be repealed in January, we’d still have our state regulated market. The people who would be hurt the most are those who now receive Medicaid coverage through the expansion and those who received the subsidy to help them buy insurance. This means there will be a lot more uninsured people. It will hurt all of those people, along with hospitals, health care providers and our state as a whole. Insurers will also be hurt, as they have done well, overall, under the ACA and they have invested a lot of money and time in its implementation.
Castro: Billions of dollars per year would be lost from Medicaid assistance, which is bad for the economy. Because of Medicaid expansion, the charity care dollars have been going down (even though it is matched by federal funds) and could leave a $500 million hole in the budget. The only way to mend that hole is by raising taxes or reducing state-funded health care services — both of which put the people in the state of New Jersey in jeopardy.
State Sen. Joe Vitale (D-Woodbridge): “I think that, given the results of (Tuesday) night’s election, and Trump’s comments during the election that he was going to get rid of Obamacare, I’m going to begin to revisit … (a universal insurance) system in New Jersey whereby we could cover most people and children. We are going to look at that and be prepared in the event Trump and the Republic Congress repeals Obamacare. If Obamacare is repealed … whatever it is replaced with isn’t going to meet New Jersey (policy) standards. Trump is talking about crossing state lines. Crossing state lines doesn’t protect New Jerseyans with (laws) we have here. So what good is that?”
Cost of drugs and prior discussions of regulation
Gary Herschman, EBG attorney, Newark: “Stocks are going through the roof for pharmaceutical companies, because there’s a lot less uncertainty about price regulation.”
BioNJ President Debbie Hart: “From where we sit, there are three key areas. Markets and what they will they do, what will the government do in terms of investment and regulation related to the industry, and patient access and how that hopefully will be enabled.”