“In the meantime, pending such repeal, it is imperative for the executive branch to ensure that the law is being efficiently implemented, take all actions consistent with the law to minimize the unwarranted economic and regulatory burden of the act, and prepare to afford the states more flexibility and control to create a more free and open healthcare market,” Trump Executive Order 1-20-17
What this is saying is that the new administration is taking the same strategy as the previous one (sort of). Simply put, they will not enforce the letter of the law to the extent it doesn’t fit the moment or political goals.
The Obama administration simply did not implement the long-term care provision of ACA fought so hard for by Ted Kennedy and was correct in doing so. It delayed the effective date of the employer mandate and the so-called Cadillac tax on high cost plans and it developed a number of exceptions to the coverage mandate. It’s goal of course was to shore up the the ACA.
Trump on the other hand has a different goal in mind. What has been done so far is largely symbolic and designed to undermine as much as possible and slow down further implementation.
Here is my prediction. Obamacare will be repealed in name only; not in substance. Some mandates will go, perhaps some taxes and other provisions will be watered down, but the basic structure will remain. Why? Because short of single-payer of some type there is no viable alternative to retain the expanded coverage let alone increase coverage. Plus like it or not, any Republican alternative so far conceived will shift more costs to individuals and will not lower the cost of health care.
There is one fundamental flaw in our current approach and in the perception of many Americans; choice‼
Offering multiple plans in any context and then allowing annual changes without restriction is simply asking for problems and higher costs. Some people will even make very poor economic choices because of the unfounded fear of medical bills leading to a net loss via unnecessarily higher premiums.
Individuals will enroll in plans they believe reflect their health care needs trying to maximize value through higher coverage or lower premiums. Insurance cannot work that way, it needs to spread risk in order to reach a reasonable premium structure. Americans and some politicians don’t seem to understand that.
You cannot establish an affordable insurance structure, especially in the highly emotional area of health care, and at the same time give everyone just what they want and perceive they need. And unlike other types of insurance, the uninsured who do need health care become a direct burden on the health care system and on society.