Repeal Replace Repeat
- 1. Repeal, Replace, Repeat Health Reform During the Trump Administration
- 2. Cedric Dark, MD, MPH @RealCedricDark
- 3. © 20th Century Fox
- 4. A Tragic Comedy • The Campaign • The Executive Order • The House • The Senate • A Surprise Victory
- 6. Campaign Promises • Repeal and replace Obamacare with HSAs • Block grant for Medicaid • Insurance across state lines • Full deductions for health insurance • Importing drugs from overseas • Price transparency for providers
- 8. Day 1: The Executive Order
- 9. The 3-Legged Stool Charles Gaba / ACAsignups.net
- 10. Day 7: TV Sabotage
- 11. Day 10: PhRMA bros
- 12. Day 38: Insurance Bros
- 13. The First 100 Days
- 14. The Honeymoon is Over
- 15. THE HOUSE
- 16. American Health Care Act • $800B+ out of Medicaid • $276B+ out of ACA subsidies • Alter the subsidy formula • Eliminate employer and individual mandate • 30% surcharge • 5:1 Age bracket • Repeal ACA taxes • Repeal MLR; Loosen EHBs
- 18. May 4, 2017
- 20. THE SENATE
- 22. Better Care Reconciliation Act • $772 billion out of Medicaid • $424 billion out of ACA subsidies & CSRs • Alter the subsidy formula • Eliminate employer and individual mandate • 6 month delay • 5:1 age bracket • Repeal ACA taxes • Repeal MLR; Loosen EHBs
- 23. Obamacare Repeal Reconciliation Act • Essentially considered “straight repeal” of ACA • Eliminate ACA mandates • Eliminate ACA taxes • Eliminate ACA subsidies • Keep insurance protections for patients
- 24. Health Care Freedom Act • Termed “Skinny Repeal” • Repeal individual mandate • Delay employer mandate to 2025
- 25. The people said: “No”
- 28. The Storm Passes
- 30. The Holy Grail
- 31. Freedom & $338B in your pocket
- 32. Essentially Repealed • “We have essentially repealed Obamacare”
- 33. Promises Kept? • Repeal and replace Obamacare with HSAs • Block grant for Medicaid • Insurance across state lines • Full deductions for health insurance • Importing drugs from overseas • Price transparency for providers
- 34. WHAT’S NEXT?
- 35. What’s Next? • CHIP Funded for 10 years • Medicaid Work Requirements • Kentucky, Indiana, Missouri
- 36. What’s Next? • Medicaid Expansion? • Virginia • Utah & Idaho • More attempts at repeal? • Trump’s budget: a Cassidy-Graham plan
- 37. Graham-Cassidy • Eliminate employer and individual mandate • Repeal premium and cost sharing subsidies • Repeal Medicaid expansion in 2 phases • Replace with block grants vs per capita caps • Within block grant EHBs other other insurance reforms don’t apply
- 38. What’s Next? Other health care issues?
- 39. What’s in store for Texas?
- 40. November 2018 © The Houston Chronicle
Editor's Notes
- #9: January 21, 2016: Trump’s order states that federal agencies can grant waivers, exemptions and delays of “Obamacare” provisions that would impose costs on states or individuals. That language appears to be aimed squarely at undoing the law’s unpopular requirement that individuals carry health insurance or face fines http://www.pbs.org/newshour/rundown/trump-executive-order-affordable-care-act/
- #11: January 27, 2017: Trump administration wanted to cut ACA TV ads; backtracked when some all already been paid for by the Obama administration. Wound up spending about 10% of the prior year.
- #12: Trump renegs on drug price negotiation in Medicare promise
- #13: Tweets: Great meeting with CEOs of leading U.S. health insurance companies who provide great healthcare to the American people.
- #14: Political Honeymoon Period.
- #19: Republicans in the House of Representatives passed what they said was their plan to repeal and replace Obamacare, after several fits and starts, sending the measure to the Senate, where it is expected to be significantly revised. The bill passed the House in a narrow 217-213 vote. All Democrats opposed the bill.
- #20: $800B+ out of Medicaid $276B+ out of ACA subsidies (alter the formula) Eliminate employer and individual mandate Loosen EHBs 5:1 Age bracket Repeal ACA taxes Repeal MLR
- #22: The ancient Romans believed all authority came from the people.
- #24: Repeals ACA mandates, taxes, subsidies. Keeps the insurance protections.
- #25: Skinny Repeal: Individual Mandate & Employer Mandate McCain gave it the “Thumbs Down”
- #27: https://www.youtube.com/watch?v=Qz1XKVvHroo
- #31: The Tax Bill
- #32: CBO and the JCT estimate that, by itself, repealing the mandate would reduce federal deficits by about $338 billion over the 2018–2027 period and increase the number of uninsured people by 4 million in 2019 and 13 million in 2027
- #33: CBO and the JCT estimate that, by itself, repealing the mandate would reduce federal deficits by about $338 billion over the 2018–2027 period and increase the number of uninsured people by 4 million in 2019 and 13 million in 2027.
- #40: Same old nothing Ballot Initiatives – not possible in Texas Change to the Legislature and Governor to expand Waivers - alternative ways to close the Medicaid Gap
- #41: Both Governor Abbott and Ted Cruz are up for re-election. Will this be a referendum on health care reform? Other other issues?