Dr. Manny on the future of ObamaCare
Senior managing editor of FoxNewsHealth.com on President-elect Trump's plans for the Affordable Care Act
EDITOR’S NOTE: This column is the final installment in a series I wrote this week examining how Trump’s health care plan, which will be referred to as THP, may look under his new leadership based on statements he has made and policymakers he has aligned himself with for his transition team and administration.
One of my favorite episodes from “The Office” dates back to season one, when manager Michael Scott was told to pick a health care plan for his staff. After being told by corporate that he cannot select the all-inclusive, high-priced “Gold” plan, which includes acupuncture and massage therapy, he hands it off to over-eager office worker Dwight Schrute, who slashes everything including dental and vision, leaving his co-workers furious and Michael in trouble with corporate. Does this plot line sound familiar?
President-elect Donald Trump will face similar circumstances, but of course on a much grander scale. He won’t be able to completely undo the ties that hold ObamaCare together, regardless of what he promised his supporters on the campaign trail, nor will he be able to keep it all in place, much to the chagrin of many Democrats. He’ll have to rely on his support team, which will include Vice President-elect Mike Pence, House Speaker Paul Ryan, former House Speaker Newt Gingrich, retired neurosurgeon Dr. Ben Carson and others to come up with a plan that will be able to outlast his administration.
While it’s likely that the majority of ObamaCare will be repealed over the next four years, it will prove crucial that Trump’s plan, THP, include enough components that Democrats favor so that the next administration may seek to alter some provisions, but not completely toss it out the window. Each of the above mentioned players put forth their own plan, and at least two have advocated for a completely insured nation, which will bode well with the opposition. It seems likely that children will be able to stay on their parents’ health plans until age 26, and that all are in agreement for a plan to be in place before ObamaCare is completely dismantled.
That mindset is likely to see much of the power shifted back to the individual states, and several plans floated by GOP members include provisions to convert Medicare from an entitlement program to give beneficiaries a certain amount of money to buy private health plans. One of the largest complaints about ObamaCare was a spike in premiums for the middle class, which Trump and his team will have to address without causing costs to skyrocket elsewhere. Medicaid spending is a likely target for cuts, but Trump will have to watch where the cuts land as state-run health agencies and services may fall victim.
What Trump lacks in political experience he makes up for in business acumen. He’s amassed billions throughout his career and survived economic turmoil by restructuring financial plans and appointing managers to oversee budget changes. I expect no different from him when it comes time to pick out a health care plan, but the responsibility must fall on his shoulders. He has said that he would like Vice President-elect Pence to play a large role in health care reform, and has previously shied away from addressing Medicaid. As president, Trump will have to play an active role in every major decision, and remember that if it starts to go sour, he won’t be able to point fingers, because it’s being formulated under his administration.
I expect that in the near future, Trump will be sitting with many members of his advisory team to figure out how they’re going to move forward with THP. Carson has singled that some aspects are already decided on, but it’s the financial aspect that will likely prevent a smooth transition. The coming weeks and months are going to prove crucial for Trump, especially since he included repealing and replacing ObamaCare within the first 100 days of his administration. How he weathers this storm will likely set the tone for his presidency, and making empty promises to some and then simply picking the loudest voice in the room will only set him up to fail.
It seems that for many years now, Washington has been operating on the art of the possible, which is why nothing constructive has been accomplished, especially when it comes to health care reform. Trump, in my opinion, operates on a different philosophy; in order to have a successful project, all considerations must take place before the project begins. I am sure that when he speaks to his engineers, and talks about building a new high-rise tower, he shares his vision with them so that those engineers can consider the logistics and come back with multiple concerns like terrain analysis, wind shear factors, construction costs, and then after all concerns have been voiced and addressed, construction can begin. In other words, Trump doesn’t take a shot in the dark when it comes to lending his name to a project, and I highly doubt that he’ll operate any differently when it comes to shaping the fate of his presidency.