Whether insurers are rejoicing at the prospect of a Trump presidency and the end of the Affordable Care Act or a Clinton presidency and modifications to the law is hard to say because of the industry’s complicated relationship with the law. AHIP, for instance, has been conflicted about the ACA from the beginning.
So far, health care hasn’t gotten much attention in an election year amped up on presidential candidates’ personalities and character, immigration, and trade issues. But insurers, pharma, hospitals, doctors, employers, seniors — all the major players in health care — know they’ve got a lot…
When the election ends, the time for rhetoric will be over and the new president and lawmakers will face the task of actually managing a giant, unwieldy, and complex health care system, trying to wrestle drug costs into submission before they wreck more havoc on the budgets of Medicare, Medicaid, and the American consumer.
Trump’s promise to repeal and replace the ACA could cut into revenues, but so could Clinton’s proposal for a public option. Readmission rates, bundled payments, ACOs — they fly under the radar of presidential politics and may continue regardless of the election results.
Clinton has come out against the Cadillac tax, but what will replace the revenue? If the ACA is repealed, House Republicans have proposed capping the tax exemption for health benefits as a way to curb the appetite for expensive health care benefits.
The ACA was health care reform that left the health care system largely intact, says Princeton sociologist Paul Starr. A Clinton presidency could mean important adjustments to the law, including addressing the omission of a public option. Trump’s proposals would, in his view, effectively end regulation of insurance, and responsible insurers should be worried about fraudulent forms of insurance entering the market.
Medicaid expansion often means a hollow benefit, says Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute and a leading conservative expert on health care policy. And the exchanges are in trouble with little political support. But Gottlieb says there will be some reluctance for sweeping reform because of a “fatigue factor,” so targeting the exchanges may be the best way forward for Republicans.