Was the Election a Referendum on the Affordable Care Act?
Let’s leave aside how wrong the polls were. It’s probably unprecedented. Donald Trump may have been the only person in America who thought he would win. His own internal polls were allegedly mirroring the polls we saw in the media. The comparisons to what happened in Britain with Brexit were parallel after all. The people have spoken.
Some have called this a referendum on the Obama Administration. While it is hard to say that is actually factual, it may have been de facto a referendum on Obamacare. If anything is certain under a Trump presidency, it may be this—the healthcare system will undoubtedly undergo a major change. Republicans in the House and Senate were poised to dismantle the Affordable Care Act, if they hadn’t won the White House. Now they control its destiny from all sides.
A few years ago I hosted a public relations workshop with Kaiser Permanente in Los Angeles to talk through some of the communications challenges poised by the Affordable Care Act. Like the election, everything we predicted about the ACA turned out differently than we expected. In all fairness, there have been as many positive contributions from ACA as negative ones, but on the whole, the public perception as indicated at the ballot box, is the final verdict.
Repeal of Obamacare won’t necessarily be easy because Democrats can filibuster and maneuver to block the 60 votes needed for a full repeal. But at the very least, Republicans will have the votes to cut key parts of funding. Major change in the healthcare system is inevitable.
On the plus side of ACA, as many as 20 million Americans are enjoying medical coverage who have never been able to afford it before. ACA did provide unprecedented access to care for many people and provided affordable insurance to many who would have gone without. Hospitals have had more paying customers and more people can afford to take their medications. That’s been good for pharma generally–and in all probability things may get better as Trump is likely to cut regulations that make it more difficult to bring needed medications to market. (Conventional wisdom thinks that anyway).
On the down side, the not so silent majority of Americans do not like Obamacare, and insurance companies are bailing out of it as quickly as they can. Small businesses say it has put a damper on their ability to hire full-time workers. And instead of reducing medical costs, premiums and co-pays have risen sharply.
A central part of ACA bans insurers from discriminating against people with pre-existing medical conditions. As it turns out, the people turning up for first-time coverage are in much worse health than the experts projected. If that provision is kept, lawmakers will have to work out more incentives for insurers to cover those at-risk patients because so far it has been way more costly than expected.
What will a Trump administration do? Back in the days when Trump was considered to be another wealthy New York liberal (which was not too long ago), he actually favored a single-payer system. One idea many state lawmakers have kicked around is expanding state Medicaid benefits. Many physicians’ groups advocate a kind of national health insurance, also known as “Medicare for all” in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands.
The real answer is nobody knows what is going to happen—but out of all the election results, the next step could be the one that impacts the lives and well-being of more Americans than any other single issue.