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What Trump Means for the Affordable Care Act

On November 8th, the GOP gained control of the White House, Senate and House of Representatives. What this means for the Affordable Care Act is uncertain. Most believe there will be changes to the program, but whether or not the President-elect will make good on his campaign promise of “Repeal and Replace” remains to be seen.  Government works slowly, and any changes to current healthcare legislation will likely not be appreciated until 2018.

The ACA had lofty goals and set new standards for virtually all private health plans. Some of those standards included a prohibition on exclusions based on pre-existing conditions and a requirement for private plans to extend dependent coverage to the age of 26. The law also established new marketplaces for the sale of individual insurance policies to all (excluding undocumented immigrants), and created new subsidies for individual coverage.

To finance these subsidies; new fees, taxes, and offsetting budget savings were adopted. Including the controversial “Cadillac Tax” on high-cost employer-sponsored plans.

Repealing the ACA is a costly proposition. The Congressional Budget Office (CBO) estimates a full repeal of the ACA would increase the federal deficit by $137 – $353 billion over 10 years (2016-2025).


During the campaign, Trump was short on details with respect to his plans. Experts speculate that “Trumpcare” will be modeled after Paul Ryan’s 2016 healthcare policy paper.

Trump advocates for a complete repeal of the ACA, including the individual mandate for coverage.  He envisions a plan where the federal government works with states to create and fund a high risk pool of individuals who have not maintained continuous coverage, rather than requiring insurers to provide coverage to everyone regardless of health status.

Trump’s agenda includes a tax deduction for the purchase of individual health insurance in place of refundable tax credits.  Trump and the GOP believe competition amongst insurers will drive costs down, and allowing insurers to sell policies across state lines will facilitate this goal.

Underutilized Health Savings Accounts (HSA) could be expanded. The GOP proposal allows for tax-free transfer of HSAs to all heirs.

Healthcare costs have continued to skyrocket. Trump’s plan requires price transparency from all hospitals, doctors, clinics and other providers, enabling patient’s and insurers to seek out fair and affordable services.


Nearly 70 million Americans are covered by Medicaid, our nation’s main public health insurance program.  Medicaid provides coverage for low income individuals and families with low or no out-of-pocket costs for care, assistance to low-income Medicare beneficiaries, coverage for long-term services, as well as direct financing to safety-net hospitals, clinics and states. Trump supports imposing a ceiling on federal funds allocated for Medicaid as a solution to the enormous budget deficit or “block-grant.” Trump indicates his plan would cover the low-income uninsured through Medicaid after repealing the ACA, but does not address how he plans to do so. The House Republican plan would offer states a choice between a Medicaid per capita allotment or a block-grant in an effort to reduce overall healthcare spending.


Almost 57 million seniors and young adults with permanent disabilities are covered by the Medicare program. Trump consistently speaks to modernizing Medicare. Talk of capping the government’s share of Medicare has been discussed, which would potentially and likely lead to a large increase of premiums for seniors. Trump’s goal is not to destroy Medicare but simply change the aspects and financial burdens it brings on the American people. That being vague at this moment; repealing the ACA would mean repealing the law’s Medicare provisions.


Prescription drug spending is the 3rd largest component of U.S. health spending. The Affordable Care Act (ACA) allows for fast-track approval of drugs that perform similarly to an existing biologic drug. Specialty drug approvals are on the rise and have outpaced traditional drug approvals. Unlike traditional drugs, specialty drugs require special administration or close observation by a physician; therefore, an increase in cost to patient’s, medical providers, and health insurance. Trump supports allowing countries to import safe and reliable drugs to the United States, generally priced lower than same/similar drugs in the U.S. He also supports price transparency from all health providers.


In 2013, 1 in 20 adults used prescription painkillers for nonmedical use. Health care expenditures, workplace costs due to lost wages and utilization of sick days, and criminal justice costs related to the opioid epidemic are an estimated $55 billion annually. Trump proposes stopping of the flow of illegal drugs into the country and closing shipping loopholes that allow dangerous drugs to be mailed into the U.S. He would also enhance access to addiction services, end Medicaid policies that obstruct inpatient treatment, increase first responders’ access to naloxone, remove restriction on the number of patients that providers can treat with recovery medicines, and expand incentives for state and local governments to use drug courts and mandated treatment to respond to the addiction crisis.


Reproductive health is an essential element of women’s healthcare. The Affordable Care Act (ACA) expanded coverage for reproductive services for millions of women. Trump calls for completely defunding Planned Parenthood if they continue to provide abortions; therefore, redirecting that funding to community health centers.

Trump in recent days, appears to have softened his stance on a full repeal indicating he would not remove the provisions forbidding insurers to deny coverage for pre-existing conditions or allowing Americans to remain on their parent’s plans until age 26. Whether he can make good on his promises remains to be seen.

By Jessica Kendrick, Esq. and Sarah Geltz, Esq.

Jessica Kendrick, Esq. and Sarah Geltz, Esq. founded Concierge At-Law in 2016 with a primary focus on physicians and the principle of providing superior legal representation and practical guidance in a proactive manner. Please contact us at 407-488-4371 for further discussion or a complimentary consultation.

Read the original article at FloridaMD.

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