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    Should Trump repeal all of Obamacare?

    Dr. KaplanAs someone who believes in healthcare for all Americans, even I know the Affordable Care Act (ACA) falls short. It turns out the ACA isn't so affordable. But there are a couple of popular aspects of the ACA (aka Obamacare) that will make it exceedingly difficult for Congress or President-elect Donald Trump to repeal the law entirely. Some aspects will have to stay and if you're not careful, your replacement plan will put you right back where you started: with Obamacare.


    Further reading: How will the Trump Administration change healthcare?


    What about the parts people like?

    Obamacare is easy to dislike. It didn't transform healthcare or lower costs. The plan essentially just gave more people Medicaid, which was never the right answer. Medicaid is state/federal insurance for the poor that reimburses facilities and doctors so badly in many places that it's difficult to find a doctor who accepts it. Sure, you can blame “money-grubbing doctors,” but if any business doesn't bring in enough money to cover costs, that's a problem. And doctors aren't as rich as many people think.

    But Obamacare did two things that were well received. First, the law allowed young adults to stay on their parents’ insurance until the age of 26. Who wouldn't like that? Second, it made it illegal for an insurance company to deny coverage based on a pre-existing condition. All very noble. There's only one problem. Those are very expensive mandates for insurance companies.


    Related: What Obamacare exits mean for physician practices


    Obviously, I'm not losing sleep over the insurance companies' well-being but there is a very real economic impact of allowing everyone to get coverage, regardless of a pre-existing condition. Keep in mind that not only can you not be denied coverage, but the insurance company can't charge you more for that coverage. That means it costs more to cover a sick person with a pre-existing condition than what they will pay in insurance premiums. Therefore, the money to cover that person comes from other, healthier folks.

    Next: What is the right thing to do?


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    • [email protected]
      The Affordable Care Act has certain provisions which President-elect Trump has indicated he will retain, such as the mandated coverage for "uninsurable" patients. Retention of this and other ACA provisions which so many ill people have come to depend upon is necessary and humane. However, employment-based health coverage should no longer be treated as a source of revenue to be tapped by the ACA. Let the government provide healthcare to those who need that assistance, and let employees go back to the lower deductibles and copays they had before the ACA. In addition, the Trump administration should take this opportunity to put the 2300 pages of new regulations in MACRA to their best possible use: as fuel to be burned in fireplaces during the coming winter months.
    • UBM User
      Perhaps I'm the dumbest old doctor left, but doesn't this admitted limited success of O'Care prove to us that the only real answer to universal insurance AND getting our national medical bill down is single payor in some form or fashion.? The US remains the only industrialized country without universal health care,and yet our tab is double the cost in Canada,and several times the cost in other countries. We are the only country with a for profit insurance,and therein lies the problem. As stated, O'Care either put more persons on MCaid-if the state cooperated- or paid part of the premium to the insurance industry. A gold mine for the insurance industry,at least until it was evident that millions of healthy young adults declined to particiapte and offset the expense of sicker patients. Health care is much too imprtant to leave to the politicians. I suggest a health care panel insulated from congress and composed of practicing physicians,hospital administrators and so on. Basically it would be Medicare for all and insurance industry could sell an equivalent of current supplement plans. All physicians and all hospitals are open to all patients. Thus, the end of the insane 'panels' and of course the end Medicare Advantage plans. The Advantage there is to the insurance industry. Considering that the congress with George Bush passed Part D and declared that Medicare could NOT negotiate drug prices, I see title hope for this, but wouldn't it be amazing if the new all Republican government passed such a bill. It would be the greatest thing since Medicare ,period.

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