The next health reform

It’s not hard to guess what it might include.

Trump’s agenda is far less detailed than the 37-page Ryan document. Of 7 items on the Trump agenda, 5 also are part of the Ryan plan: (1) complete repeal of the ACA; (2) permitting interstate sale of health insurance; (3) allowing individuals to deduct the cost of health insurance premiums on their federal tax returns; (4) expanding use of health savings accounts; and (5) reforming Medicaid by implementing state spending block grants (or per beneficiary enrollment caps as an alternative under Ryan’s plan). Trump’s plan also promotes price transparency for physicians and hospitals, and would permit the importation and domestic sale of drugs with regulatory approval in other countries.

Ryan’s plan includes more details on the proposals it shares with Trump’s approach, plus policy proposals not included in Trump’s plan. Most of Ryan’s proposals reflect recommendations that are also key elements of other Republican and conservative plans, such as: capping the tax deductibility of employer provided health insurance; nationwide limits on noneconomic damages in medical liability litigation; continuing the ACA’s guaranteed issue of health insurance though only for individuals who maintain “continuous coverage,” and reestablishing state high-risk pools for uninsured persons with preexisting conditions; not allowing expansion of Medicaid as permitted by the ACA in states that had not expanded Medicaid by January 1, 2016; raising the eligibility age for Medicare to 67 years; and moving Medicare toward a premium support financing structure to limit the federal government’s financial obligations.

Many of Ryan’s proposals are ambiguous. Moreover, the plan has not been written in legislative language, preventing scoring by the Congressional Budget Office to determine the likely cost and the impact on health insurance coverage. Regarding the Trump proposals, an analysis by the Committee for a Responsible Federal Budget, a nonprofit, nonpartisan organization, concluded that it would increase the number of uninsured by 21 million by 2018, raising the number of uninsured Americans from nearly 30 million to about 50 million, and increase the federal budget debt over 10 years by between $330 and $550 billion.

That’s from a recently published JAMA Internal Medicine Viewpoint by John McDonough and David Jones to which I’ve inserted links. Find more here.

UPDATE: Per my tweets, here’s more on this topic.

See also Tim Jost and Margot Sanger-Katz.


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