Trump-in(g) healthcare landscape

Few things to consider from Trump’s campaign this year:

• Prioritizing home care benefits
• Supporting unpaid family caregivers through tax credits and reduced red tape.
• Enhancing Medicare Advantage plans including increasing of access to Telehealth and expanding the supplemental benefits for seniors with chronic diseases.
• Retooling the health law.
• Will not try again to repeal the Affordable Care Act.
• Trump has vowed to roll back parts of the Inflation reduction Act
• Not to make cuts to the two largest programs

Supporters of Donald Trump including officials who worked in his previous administration believe that he will improve the law that in turn would lower the cost.

The uninsured US population which was at 17%, when the Affordable Care Act (ACA) was enacted in 2010, is now at 8%. However, Republicans including Trump’s administration hold strong views against the Affordable Care Act, also known as Obama Care. They believe federal funding extended to ACA could be used for better tax reforms and the uninsured rate could be improved by injecting more competition into market, in the form of affordable short-term plans.

In 2017, attempts to repeal the ACA, was overturned by some GOP lawmakers, stating that it would increase the uninsured rate. Industry experts gauge similar opposition is likely to happen this time, pointing to the public opinion being in favor of ACA
Even though, Trump has said he will not try again to repeal the ACA, his administration needs to decide whether to back an extension of enhanced premium subsidies for ACA insurance plans. Officials doubt the renewal of the enhanced subsidies at the end of 2025.
Democrats worry, that slashing the funds could cause steep premium increases, in turn can bring down the enrollment and increase the uninsured rate.

In a nutshell, these plans limit the coverage to provide shorter policy duration, and fewer medical services, thus reducing the premium and mostly being non-ACA compliant.
During previous Trump’s administration, the insurance market saw these plans increasing in numbers.
Regarding the quality of the plan’s providence, the Biden administration tried to walk back the steps taken to promote this plan during Trump’s previous tenure, calling these ‘Junk’, because they coverage is limited for much shorter duration and restricts enrollees with preexisting conditions.
Healthcare experts expect the same this time – a sharp spike in Short term plans, sometimes with extended duration.

Trump has vowed to rollback parts of the Inflation Reduction Act(IRA), passed in 2022, which introduced many drug price reforms. IRA allowed federal government to directly negotiate prices with pharmaceutical companies, thus reducing the prices of 10 drugs which are covered by Medicare, starting from 2026. About 1.4 million Medicare Part D enrollees paid more than $2,000 out of pocket per year (averaging at 3,355/person)for medications in 2020. IRA capped out of pocket costs at $2,000/year for prescription drugs.
It should be noted that, this ‘Inflation Reduction Act’ in 2022 extended the enhanced ACA subsidies.

The pros and cons of insurer-run plans and effective privatization of Medicare (which is funded largely by payroll taxes and covers 66 million people) may become the topic of argument among the public and official circle, when talking about steps taken by many congressional Republicans including Trump to aggressively promote Medicare Advantage.
Reports indicate, in 2023, Medicare Advantage plans cost the government and taxpayers about 6% which is approximately $27 billion more than the traditional Medicare, though some research shows they provide better care.
Conservatives believe Medicare beneficiaries are better off on MA plans than the traditional government-run program, though critics say increasing insurer-run program would trap consumers in health plans that are costlier to taxpayers which eventually can restrict their care.

The most expected slashes hover around Medicaid, which is the 3rd largest program in the federal budget(Spending $616 billion in 2023). One of Trump’s campaign promises is not to make cuts to the two largest programs( Social Security & Medicare), which makes Medicaid (covering lower-income and disabled people) the obvious guess. – one of KFF officials said.
Possible line items in the action list include trying to add work requirements for Medicaid recipients which occurred during Trump’s previous term and try to cap federal Medicaid spending allocated to states, which is uncapped now.
Trump and Republican lawmakers believe that policy reforms consisting of spending cuts would free up federal funds that may help other Republican policy priorities including tax cuts. The Medicaid Expansion Program implemented in 9 states including Arizona and Indiana provides coverage for 3.7 million low-income people. These states have ‘trigger laws’ that would end their ACA Medicaid expansion if federal funding falls.

Public and healthcare professionals expect possible changes that might restrict the right to abort, however experts say the potential future of reproductive health is less clear.
In regards to abortion, Trump has said the followings before election:

• That he wouldn’t sigh a national abortion ban,
• Decisions about abortion restrictions should be left to the states.
  – At present, 13 states ban abortion with few exceptions, and 28 states restrict the procedure based on gestational duration.
• And he generally wouldn’t use the law to ban mail delivery of the drugs.
  – Healthcare circle generally assumes that Trump could restrict access to abortion medications either by withdrawing the FDA’s authorization for the drugs or by enforcing the ‘Comstock Act’ – a 19th century law which bans the shipment of abortion related matters.

Public health authorities worry that U.S. could witness increase in preventable illnesses, public confidence getting weaker in established science, policies to be made based on unproven notions such as vaccines and associated medical conditions – All pointing to Trump’s association and inclusion of people to his inner circle of advisers, someone like Robert F. Kennedy Jr. (Famous for his vaccine skepticism, and works on eliminating fluoride from U.S. drinking water. )