Trump's next health care bill: Medicaid for all?

Donald Trump knows almost nothing about healthcare policy. He doesn’t know what’s in the ACA/Obamacare or how it works –just that it’s a “disaster,” and since the abandoned American Health Care Act ran directly counter to his promise to “take care of everybody” it’s fair to assume he doesn’t care about what’s in these laws either. He just wants a big win.

A lot of the populist attacks on Obamacare boil down to the individual exchanges/marketplaces. People complain about high and rising premiums and point their finger at Obama. Frankly, I’m skeptical about many of these complaints. Premiums were rising faster before the exchanges came into being and it was often impossible to get insurance if you were sick or had a pre-existing condition. Also, most Obamacare exchange users receive significant subsidies and many receive help on out-of-pocket payments as well. And let’s remember that Republicans at the state and federal level have been trying to sabotage the exchanges by refusing to set up state exchanges (despite supposedly being in favor of state-level control), not funding risk corridors, not advertising for members, resisting the hiring of exchange navigators, spreading misinformation about the program, and more.

But I say to Obamacare haters: go ahead and unplug the exchanges. They are a Republican idea anyway. Replace them with something better if you can think of it –my guess is you can’t.

Now, what to do with the people who are thrown out of coverage by a shutdown of the exchanges? The Congressional Republican approach appears to be to let insurers sell skinnier policies that more people can afford, while enforcing the retention of popular Obamacare policies like a ban on medical underwriting and allowing people to stay on their parents’ plans to age 26. That won’t work –as they’ll find out if they ever put it in place, and the number of uninsured people will skyrocket.

So here’s a radical idea: kill off the exchanges and let insurers do whatever they please in the individual market. But at the same time make Medicaid available as a cheap backup plan for anyone who wants it. It will be free for the poor as it is today, but others can pay some fraction of the cost based on their income. No need to rely on the Obamacare exchanges in that case. And Medicaid is better than other federal and private programs at keeping costs under control, so it will be a double win. We already see that the Medicaid expansion is becoming popular in Republican led states, so why not just expand it some more?

Obamacare opponents can dress up the Medicaid for All bill however they like. In fact, why not include some of the big GOP “ideas” that will have little to no practical effect and say that’s what made the law work? I’m referring to allowing health plans to sell across state lines, promoting drug reimportation, allowing tax deductibility for individuals’ purchases of health insurance, and expanding Health Savings Accounts.

As I’ve said in the past (Goodbye Obamacare? More like hello single payer!) Donald Trump will have us on the path to socialized medicine faster than you can say Vladimir Vladmirovich Putin.

Images courtesy of Thanamat and Stuart Miles at

By healthcare business consultant David E. Williams, president of Health Business Group.

April 3, 2017

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