Trumpcare =  Predicate for Tax Reform

With Republicans in the White House and holding majorities in both houses of Congress it seemed that nothing could stand in the way of repealing and replacing the Affordable Care Act (ACA), also known as ObamaCare, however, after years of campaigning on this issue, no consensus bill, in fact, has been developed by either Congress or the new Administration. The first attempt to repeal and replace the (ACA) came on March 6, 2017 with the introduction of the American Health Care Act (AHCA). On March 24, 2017, the ACHA bill was withdrawn. It failed for many reasons, tops among them the Congressional Budget Office assessment that 24 million people would be rendered uninsured by 2026 relative to current law, concentrated ironically in low-income demographics who had voted for the president, pushback from Republican governors who had had expanded Medicaid, and coverage for people with pre-existing conditions.

Focus has turned to ensuring the government does not close on April 28th and on tax reform. However, the Administration keeps signaling that they would like Congress to take up healthcare again, to fulfill campaign promises, but also to secure the $337 billion in deficit reduction gained from pulling subsidies and reduced revenues from repealing the ACA.  This money has been discussed as wanted to pay for infrastructure projects, a wall on the southern border, or further tax cuts.

The immediate danger is the threat by the Administration to withhold cost-sharing payments to insurers. This would result in the destabilization of healthcare exchange markets, furthering the withdrawal of insurers from markets, leaving less choice and likely higher premiums on the lower base of insured.

A lesson for those constructing healthcare policies: Healthy people are the nation’s true infrastructure.  Hard lesson to learn when the Surgeon General, the top Administration envoy on public health, is now one of the many health and science positions that stands empty.