Introducing America's new health care system: Trumpcare

Updated 10/15/17 A version of this was published in the Sky Hi News, Oct 18, 2017 http://www.skyhinews.com/news/muftic-welcome-your-new-health-system-trumpcare/
Introducing America’s new healthcare system: Trumpcare.  Donald Trump just  broke the old one; he owns the new one.   He can no longer blame Congress that  also tried to break it and failed.  He is the one who broke it all  by himself with his own executive orders. It gives some the choice of cheaper policies, but their new choice is between bad, worse and useless. All premiums in and out of exchanges will rise. The financial impact will be felt immediately in everyone’s pockets. Trump has opposed any  suggested fixes that would make his orders unnecessary.

However, facing 2018  Congressional elections, he claims he is ready to make a deal with Democrats , it appears . No wonder. The political repercussions will be felt in time for the 2018 midterms when the  millions of lower income and middle class voters will feel the pain in their pockebooks and realize  in real time  they  just  been taken to the cleaners by Trumpcare. Given insurance policies fine print, most will only learn the consequences when they get sticker shock, paying full price for needed services not covered by terms, deductibles, and lifetime and annual caps. The most affected are red states that use more of the subsidies he just halted and who voted for Trump Alternatives such as single payer and Medicare for All will begin to look better and better to more. If Trump blames greedy insurance companies, then single payer solves that problem: it cuts out private health insurance participation.  Congressional  Democrats in the short term are united in support of fixing Obamacare in contrast to Trumpcare. Deal with Trump? Chuck and Nancy have already been bitten with DACA's deal with him over that. They were double crossed later . Don't blame them if they do not take him up with his offer.

Trump’s  threats to stop payments to insurance companies who help low income pay insurance premiums (not to prop up their stock prices as Trump claims)  have already caused exchange premium prices  to rise 20-25% in some states since  insurers anticipated his move. October 12 he made good on that threat with his order.  Per a recent Congressional Budget Office score , the impact on all  premiums  of the payment stop will  be an average increase of  20-25%..  An estimated seven million who buy insurance through the insurance exchanges  will find premiums hiked, but so will the subsidies increased to help them pay.  This order   will raise the deficit by $194 billion over ten years since the government will make up the difference in subsidies and insurance companies will pas on costs to everyone else in higher premiums, or the insurance companies will just drop out of the program.

Trump’s order includes a creation of a parallel system of  cheap association plans. There  will be no  requirements for  them  to cover anything so essential to many: prescription drugs, hospitalization, low co pays or affordable deductions, maternity care, cancer screenings including prostate and mammograms,  annual physicals,  pre-existing conditions, mental health care and drug rehab. Consumers buying into association plans  wanting  to make up the the unanticipated loss of uncovered benefits  would pay extra  from their pockets at  full  market price or go without. That is Trump's definition of "great care".

Currently fourteen million buy their insurance through the exchanges. The only ones who benefit from Trumpcare will be the two million  buying  insurance through the exchanges who make too much money now  to get subsidies. Even then, Trumpcare  will  bait and switch them  to accept his "great care"  association plans that resemble  a hamburger with   two buns but with  little meat and condiments .

The eventual   financial failure  of Obamacare is not the death spiral caused by Obamacare,  but it a death spiral engineered by the Trump administration on purpose as part of their plan to de facto repeal  it.  In time, the entire  Obamacare private insurance  based exchange system will collapse as the  parallel  association system will destroy the ACA’s “pool” comprised of  both those  with the healthy  who lightly place claims and  those with pre-existing conditions or with health problems.The  healthy will be  lured into cheaper stripped down plans. The result will be virtual high risk pools left to the sicker who   will see their premiums soar to become unaffordable.

This executive order  is such a fundamental change to the intent and financing of Obamacare, that it is the mother of all executive overreach.  resulting in court challenges which will further drag out uncertainties and  will cause continued premium increases  for everyone as the market is destabilized.

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Footnotes: A bipartisan "fix" to the subsidies has emerged from a Senate committee, but its fate is unknown.  GOP Senate leadership may refuse to bring it to the floor. Then it must pass the Senate and go to the House and require the President's signature.  Trump has issued various conflicting views on his support. http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Trump  may want to pay attention to the following impact on his core base of supporters and red states:

Criteria: access, quality, numbers applied for financial aid to afford health care in a recent study revealing 15 worst states to get health care. https://www.cheatsheet.com/culture/worst-states-live-want-decent-health-care.html/

All but one (Nevada) voted for Trump in 2016. The 5 worst: in order of the worst first
Arkansas, Mississippi, Oklahoma, Alabama. W. Virginia.

According to the Associated Press. Nearly 70 percent of those benefiting from the so-called cost-sharing subsidies to insurance companies live in states Trump won last November. https://twitter.com/AP/statuses/919246698081288192

https://www.forbes.com/sites/brucejapsen/2017/10/08/how-narrow-networks-doom-trumps-insurance-sales-across-state-lines/#7e4ea38a35f9.

http://www.npr.org/sections/health-shots/2017/08/15/543714171/cbo-predicts-rise-in-deficit-if-trump-cuts-payments-to-insurance-companies

"Blog posting: 9/271/17 Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives
ies https://www.pbs.org/newshour/amp/bb/trump-ending-obamacare-subsidies-health-insurers-heres-ends-paying

http://www.chicagotribune.com/news/nationworld/politics/ct-trump-health-care-executive-order-20171012-story.html

https://www.yahoo.com/news/pro-trump-states-most-affected-health-care-decision-134810734.html

https://www.usatoday.com/story/news/politics/2017/10/12/trumps-health-insurance-order-pushes-association-plans-drive-down-costs-some/752816001/

https://www.washingtonpost.com/powerpost/key-senators-reach-bipartisan-health-care-subsidy-deal-and-trump-expresses-support/2017/10/17