Where President-elect Donald Trump Stands on Six Health Care Issues

2016election_pad-20pxWhile health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.

President-elect Donald Trump has laid out different approaches to addressing these and other health care issues. Central among these is his position to fully repeal the ACA.

See where he stands on six key health policy issues.

Health Insurance Coverage and Costs

The Affordable Care Act (ACA) set new standards for virtually all private health plans, including a prohibition on pre-existing condition exclusions and a requirement for private plans to extend dependent coverage to the age of 26.  The law also established new marketplaces for the sale of nongroup insurance to all individuals except undocumented immigrants, and created new subsidies for nongroup coverage.  New fees, taxes, and offsetting budget savings were adopted to finance ACA subsidies and reduce the deficit, including a so-called “Cadillac tax” on high-cost employer-sponsored plans.  The Congressional Budget Office (CBO) estimated repeal of the ACA would increase the federal deficit by $137 – $353 billion over 10 years (2016-2025).  Since enactment, the uninsured rate has fallen to 8.6% and an estimated 20 million Americans have gained coverage, while 27 million remain uninsured.  Public opinion about the ACA remains divided, largely on partisan lines. Several issues have emerged in the 2016 campaign.

Donald Trump supports complete repeal of the ACA, including the individual mandate to have coverage.  In lieu of requiring insurers to provide coverage to everyone regardless of health status, he would work with states to create high risk pools for individuals who have not maintained continuous coverage. In place of refundable premium tax credits, Trump would provide a tax deduction for the purchase of individual health insurance.  He would promote competition between health plans by allowing insurers to sell plans across state lines; an insurer licensed under the rules of one state would be allowed to sell coverage in other states without regard to different state laws that might apply.  He would promote the use of Health Savings Accounts (HSA), and specifically would allow tax-free transfer of HSAs to all heirs.  Trump would also require price transparency from all hospitals, doctors, clinics and other providers so that consumers can see and shop for the best prices for health care procedures and other services.

The Opioid Epidemic

In recent years, the use of prescription painkillers for nonmedical purposes, as well as drugs derived from opium (such as heroin), has emerged as a major public health issue. In 2013, 1 in 20 nonelderly adults used opioids for nonmedical purposes. For one in five users (almost 2 million nonelderly adults), the nonmedical use of opioids increases to the level of opioid use disorder, often referred to as abuse, dependence, or addiction. Overdose deaths involving opioids have quadrupled since 1999, with over 14,000 individuals dying from opioid overdoses in 2014, leading to what many refer to as an “opioid epidemic.” The opioid epidemic creates an estimated $55 billion annually in societal costs, such as health care expenditures, workplace costs due to lost wages and utilization of sick days, and criminal justice costs. Proposed policy actions to address the opioid epidemic include efforts to change prescribing practices to curb utilization of opioids, improve access to treatment for individuals with opioid use disorder, and enforcing drug laws to combat access, sale and use of illicit drugs.

Donald Trump has said he will stop of the flow of illegal drugs into the country by building a wall on the U.S.-Mexican border and closing shipping loopholes that allow dangerous drugs to be mailed into the U.S. He would also enhance access to addiction services, end Medicaid policies that obstruct inpatient treatment, increase first responders’ access to naloxone, lift the cap on the number of patients that providers can treat with recovery medicines, and expand incentives for state and local governments to use drug courts and mandated treatment to respond to the addiction crisis.

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