Perspectives On Health Reform: How Will The Election Affect The Path Ahead?
Commentators analyze how the election could affect the politics around the health law and possible changes.
JAMA Forum:
Action on the ACA Next Year? Maybe.
What are the prospects for action on the Affordable Care Act (ACA) during the next Congress and presidential administration? There is no easy answer to that question in this unusual election year .... At the risk of being proven wrong, it also seems reasonable to assume that there will continue to be a political standoff in practice next year, with neither party able to push through its preferred solutions for health care. And the Republican “Repeal Obamacare” mantra seems to leave little space for compromise. But a standoff could also lead to interesting prospects for some agreement, assuming that repeal of the ACA remains a nonstarter. (Stuart Butler, 9/14)
The New England Journal of Medicine:
From Obamacare to Hillarycare — Democrats’ Health Care Reform Agenda
What happens to Obamacare after its namesake leaves the White House? ... If Donald Trump becomes president and Republicans maintain congressional majorities, the GOP could seek to repeal major ACA provisions, though Trump’s health care agenda is uncertain. If Hillary Clinton wins the presidency, however, Democrats can advance the ACA. For decades, reformers sought to enact universal health insurance. Now that they’ve taken a major step toward that goal, what happens next? Victory in the 2016 elections could allow Democrats to shift their focus from preserving the reforms to strengthening and improving them. (Jonathan Oberlander, 9/14)
The New England Journal of Medicine:
What Would A Republican Win Mean For Health Policy?
Republicans may be willing to provide support for strategies to help stabilize the ACA insurance exchanges — such as continued use of risk corridors (which limit the amounts that insurers can gain or lose through risk sharing) after 2016, perhaps with some increased funding from existing appropriations in exchange for increased flexibility using innovation waivers (1332 waivers), such as allowing budget neutrality to be measured over 3 years rather than 1 and allowing states to pool savings from Medicaid with those from exchanges. Agreement that states that have not previously expanded Medicaid should be given 100% federal funding for Medicaid for 3 years after 2016 might be attractive to both Republicans and Democrats. The government could also smooth transitions between Medicaid and exchange coverage by letting people use their Medicaid subsidies to buy insurance in the exchanges and their exchange subsidies to buy Medicaid coverage. (Gail R. Wilensky, 9/14)
National Review:
Repeal Without Replace?
It cannot be ruled out entirely that Donald Trump will be elected president on November 8. It is therefore only prudent to begin thinking about what might happen if that actually were to occur. One thing that is fairly certain is that, on November 9, we’d hear loud calls from some quarters for the incoming administration and Congress to move quickly in 2017 on a “clean” repeal of the Affordable Care Act — a.k.a. Obamacare. What people mean by “clean” is that the bill would go as far as possible (within legislative constraints) to repeal the ACA without being encumbered politically by new provisions to replace it. ... Regardless of Trump’s inclinations, however, it would be a terrible idea — for substantive and political reasons — for Republicans in Congress to pursue repeal without replace in 2017. (James Capretta, 9/14)
