Blog Post

Post-election Q&A: What Now?

Nov. 21, 2016

While the future of health care in this country is unclear and may be for some time, Healthforce Center at UCSF’s health policy experts can tell you what they know now, in addition to the best ways to stay informed and get involved.

What will happen to Obamacare?

Major modifications to the Affordable Care Act are likely, but a full repeal will be difficult. The fundamental drivers that made health care reform necessary—cost of health insurance and increasing premiums, increasing percentage of national GDP spent on health care, and uneven quality of care—are still present today. Without a Republican supermajority in the Senate, Democrats can filibuster, making a complete repeal challenging. However, a budget reconciliation process could be used to repeal fundamental building blocks, including insurance subsidies and expansion of Medicaid to low-income, uninsured individuals. There has also been discussion of a “repeal and delay” strategy, in which a vote for ACA repeal would occur quickly, but the actual dismantling of the ACA would be delayed until a replacement plan is in place.

We’ve heard Trump talk about allowing insurance companies to sell across state lines. Would this really lower costs and give consumers more options?

This would probably have only a small effect. It’s a myth that big cost savings would result, although think tanks have been pushing this idea for many years. Simulation models have shown that this proposal will reduce costs by a modest amount, at best, and make only a dent in the number of people who sign up for health insurance. It could not make up for the large numbers of people who have gained health insurance through Medicaid expansions and insurance premium subsidies offered through health insurance exchanges.

What elements of the Affordable Care Act will remain unchanged?

It appears highly likely that people with pre-existing health conditions will be protected and young adults on their parents’ plans will still be covered until age 26. These are popular components that President Obama and Senate Republicans support.

What elements of the Affordable Care Act will likely be repealed?

Many Republicans are eager to eliminate the individual mandate, which requires consumers to either buy a health plan or pay a tax penalty. But, without a mandate, premiums could go through the roof. Therefore, they have discussed the idea of health insurance subsidies, which would encourage consumers to voluntarily buy insurance. Whether those subsidies are based on age, income or other factors remains to be seen and will likely be debated in the coming months. Mandates that require employers to provide health insurance may also be revoked.

In addition, Trump and House Speaker Paul Ryan have endorsed the idea of transforming Medicaid from an entitlement program into a block grant program. This would allow states to have more latitude in designing their Medicaid programs, and they would not have the financial incentive of matching funds to offer more generous coverage. This could ultimately lead to millions of low-income people losing health insurance in less-generous states.

What about Medicare?

Trump hasn’t said, but Ryan has been forthright about his vision of privatizing Medicare, which provides health insurance for more than 55 million older adults and people with disabilities. His proposal would provide funds for individuals to purchase health insurance from private insurance companies, which has the risk of increasing health care costs for many older adults who are on fixed incomes, and leaving others with inadequate insurance coverage.

What will happen to other government agencies that are engaged in health care and health services research?

We don’t know what will happen yet, but it is important to remain vigilant about:

  • Trump’s appointment for Department of Health and Human Services Secretary.
  • The Health Resources and Services Administration (HRSA), which provides financial support for health care programs for vulnerable populations across the country.
  • The Agency for Healthcare Research & Quality (AHRQ), which produces evidence-based recommendations and information to make health care safer, better, more accessible, more equitable and more affordable.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA), which leads public health efforts to advance the behavioral health of the nation. 
  • The Patient-Centered Outcomes Research Institute (PCORI), a government-sponsored organization funded by the Affordable Care Act, and charged with investigating the relative effectiveness of various medical treatments. 

What are good sources of information to remain up-to-date on health care policy and news?

Healthforce Center at UCSFPolitico, Kaiser Health News, Morning Consult, California Healthline, STAT News and the National Association for State Health Policy. 

How does the election change the work done at Healthforce Center at UCSF?

Regardless of how these changes play out, our mission is unchanged. Our work is driven by a desire to shape policies so that all people in our country have access to needed health care services, and that individuals and policymakers make wise use of our limited resources. Health care leaders not only need to comprehend and navigate major changes in the system, but they also need resilience to execute a vision and strategy.

What actions can individuals take to influence policy decisions in this country?

About Healthforce Center at UCSF Research Faculty

Healthforce Center at UCSF’s research faculty brings extensive interdisciplinary knowledge from across a variety of fields including economics, sociology, public health, medicine, dentistry, nursing and pharmacy. They focus research on issues impacting health care professionals, now and in the future. Meet the team.