Author: Krystal Lau Edited by: Burcu Anil Kirmizitas
2016 is drawing to a close. Inevitably, we are all looking back on it and are reminding ourselves of the most important events of the year. Needless to say, one of them is the American presidential election. “America has spoken” read the headlines back in November. A man once mentioned in the likes of “The Apprentice” and “Trump Organisation” is now referred to as “President-elect Donald Trump”. In the wake of what many consider to be an incredibly shocking result in the presidential election, a series of questions remain unanswered about the future of America, including those surrounding Obamacare. Will Donald Trump repeal Obamacare as he vowed to throughout his campaign? If so, what does he plan to put in place in its stead? Does he have a viable plan?
His plan, colloquially dubbed “Trumpcare”, is surprisingly more thought out than expected, yet remains relatively vague (1). It is outlined in seven points, the first of which is repealing Obamacare, specifically the requirement of health insurance. He pushes for the sale of health insurance across state lines and allowance of individuals to claim health insurance premiums as tax-deductible. He follows with the creation of a Health Savings Account (HSA) that individuals can contribute to, tax-free. He plans to mandate price transparency of costs of procedures and operations by doctors and hospitals. Finally, he proposes to block-grant Medicaid to states, allowing them the flexibility to spend as they see fit, and reduce barriers to entry for foreign drug providers.
What is perhaps most alarming about this plan is that to the average person, it sounds good. Having no penalty for not having health insurance might appeal more to the young and the healthier than the wealthy individual who does not utilise the full extent of their health coverage. From an economic standpoint, others argue that this might lead people to purchase insurance only when they are sick, which can get quite expensive. From a purely health standpoint, however, the consequences can be much worse. The coverage mandate of Obamacare gave many people, especially those who were previously uninsured, the opportunity to visit their primary care physician more regularly than before. Patients who cannot utilise primary care may allow their condition to worsen until it warrants an emergency visit; at which point, the patient may be in such poor health that they are subsequently hospitalised. By increasing access to primary care, people can receive the preventive maintenance that they need to better manage their illness and reduce costly emergency interventions. Essentially, if you take your car for regular oil changes and maintenance check-ups, why should your body be any different?
To be fair, some aspects of Trumpcare should result in savings. According to the Committee for a Responsible Federal Budget (CRFB)’s ten-year projection, repealing Obamacare’s coverage provisions (subsidies, Medicaid expansion, Medicare savings and tax increases) should save $1.1 trillion (2). What is not mentioned in Trump’s healthcare plan, however, are the external costs that would arise as a consequence of this repeal. Repealing tax increases and Medicare savings would inevitably cost the government so much that the CRFB estimates a net deficit of $260 billion. As for Trump’s other action items, the CRFB estimates that allowance of cross-state purchase of insurance and foreign prescription drug imports would save money, but tax deductions on health insurance premiums would actually result in a net loss of $70 billion. Therefore, they suggest that over the next ten years, Trumpcare would reduce total expenditures at first, but will eventually cost the US government around $330 billion, a deficit that will only increase over time.
In addition to actually increasing healthcare spending, the Congressional Budget Office (CBO) estimates that around 21 million Americans will be left without health insurance, only further exacerbating the health and economic issues that come with uninsured individuals. Other aspects of Trump’s plan raise more questions than they answer, including his plans for block-granting Medicaid and how he will get around the Federal Drug Administration (FDA)’s stringent requirements on drug quality to increase the import of foreign prescription drugs.
From a bird’s-eye view on health and the economy, Trumpcare would invite more harm than help. His plan for healthcare reform would ultimately increase government spending. It would also reduce the health of many individuals, which will in turn, feed back to the government as increased costs. The bottom line is that more uninsured individuals mean less regular health maintenance and existing illnesses worsening, to the point where costly emergency intervention is required. These expenses place strains not only on the individual, but also on hospitals and the government, who must pick up the tab that would have been much smaller if access to insurance and therefore primary care were improved via Obamacare. And if you are an American citizen thinking that the burdens that come with Trumpcare will not affect you, ponder this: At the end of the day, who picks up the government’s tab?