These short posts are part of a series to take stock of changes that may be coming during a Trump Administration.

Healthcare

1. The Republican are very unlikely to keep their promises:
   1. Forcing insurers to cover preexisting conditions and to allow children to stay on their parents’ insurance policies through age 26 is very costly to the insurers, especially if the subsidy program to help people afford coverage is eliminated.
   2. Switching from subsidies which reduce a person’s monthly premiums to a tax credit a year later means that people who can barely afford to pay for insurance now have to find a whole lot more money each month to afford insurance coverage during the year. Many will go without.
   3. Even without insurance, everyone can get healthcare through emergency room visits which are hugely expensive and will eventually bankrupt both the patients and hospitals if too many people are without insurance coverage.
   4. Under the Republican proposals, you would end up with a system in which only the wealthiest 40% and those who must have insurance for a preexisting condition buy insurance in the individual market. Healthy people will take their chances.
2. Many health insurers will pull out of most markets because the plans lose money.
   1. The individual market will likely collapse in rural areas because there is no incentive for the only hospital or the only radiology group to cut their fees and make deals with insurers when they have no fear of competition within fifty to three hundred miles.
   2. The same may be true for mid-size cities because of hospital consolidation. It is common for the financially stronger hospital in an area to buy the smaller, weaker ones, and once again, there is less incentive to negotiate with insurers.
3. One Republican proposal which seems likely involves switching Medicaid to a block grant system. The federal government sends money to the states and they figure out what to do with it. In such a scenario, it’s likely that some, and possibly many people currently covered by Medicaid will lose benefits. They same block grant program could happen with Medicare and other programs in this ‘states rights’ leaning federal government.
4. Over one-third of Americans have at least one preexisting medical condition.
5. Whatever changes occur, they are more likely to benefit wealthier Americans and harm poorer ones. For example, the Affordable Care Act levied a 0.9% additional Medicare tax on income over $250,000 per year and Republicans have promised to get rid of that tax.
6. Attorney General Jeff Sessions has taken a clear stance against medical marijuana and it’s possible the federal government will crack down on its use.
7. When the dust settles, it’s possible that we will have a slightly tweaked Affordable Care Act (“Obamacare”) or a big change to a single-payer system (“socialized medicine”) supplemented by pay-as-you-go options for those of means.