Universal coverage reforms in the USA: From Obamacare through Trump

• Published in: Health policy (Amsterdam) 2018-07, Vol.122 (7), p.698-702
• Main Authors: Rice, Thomas, Unruh, Lynn Y., van Ginneken, Ewout, Rosenau, Pauline, Barnes, Andrew J.
• Format: Article
• Language: English
• Subjects: Affordable care act; Compromises; Cost sharing; Elections; Employers; Flexibility; Health administration; Health care access; Health care expenditures; Health care industry; Health care policy; Health Care Reform - economics; Health care system; Health insurance; Health Insurance Exchanges; Health policy; Health reform; Humans; Insurance Coverage - economics; Insurance, Health - economics; Legislation; Legislatures; Management; National health insurance; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act - legislation & jurisprudence; Political parties; Politics; Prospects; Reforms; Subsidies; Uninsured people; United States; Universal Coverage - economics
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2018.05.007

•President Trump’s administration is undoing some of the Affordable Care Act’s provisions.•The individual mandate to purchase coverage has been repealed.•Medicaid remains but premiums in insurance exchanges rose considerably in 2018.•Political compromise possible in short-run; long-run depends on upcoming elections.•In the meantime, prospects are that the number of uninsured will grow. Since the election of Donald Trump as President, momentum towards universal health care coverage in the United States has stalled, although efforts to repeal the Affordable Care Act (ACA) in its entirety failed. The ACA resulted in almost a halving of the percentage of the population under age 65 who are uninsured. In lieu of total repeal, the Republican-led Congress repealed the individual mandate to purchase health insurance, beginning in 2019. Moreover, the Trump administration is using its administrative authority to undo many of the requirements in the health insurance exchanges. Partly as a result, premium increases for the most popular plans will rise an average of 34% in 2018 and are likely to rise further after the mandate repeal goes into effect. Moreover, the administration is proposing other changes that, in providing states with more flexibility, may lead to the sale of cheaper and less comprehensive policies. In this volatile environment it is difficult to anticipate what will occur next. In the short-term there is proposed compromise legislation, where Republicans agree to provide funding for the cost-sharing subsidies if the Democrats agree to increase state flexibility in some areas and provide relief to small employers. Much will depend on the 2018 and 2020 elections. In the meantime, the prospects are that the number of uninsured will grow.