- In the wake of Tuesday’s election, healthcare providers, payers and policymakers are scrambling to understand what a Donald Trump presidency means for the industry.
- During his campaign, President-elect Trump promised to repeal and replace the Affordable Care Act, but didn’t offer much in the way of a replacement policy.
- Even if the ACA is repealed, some form of Medicaid expansion might survive, Modern Healthcare reports.
Under the ACA, states can expand Medicaid eligibility to people living at up to 138% of the federal poverty level. Currently, 32 states and the District of Columbia have done so, insuring more than 12 million people through their Medicaid programs.
While officials in some Medicaid expansion states have vowed to do what they can to maintain coverage levels, those in other states are taking a wait-and-see approach since the ACA is still in effect.
States that voted for Trump but expanded Medicaid might have a weird time going forward. “Right now nobody knows what tea leaves to read — or if they’re going to be coffee beans,” Scott Borgemenke, senior vice president and lobbyist for the Ohio Hospital Association, told the Cincinnati Business Courier.
Ohio hospitals and Medicaid managed care plans have fared well under Medicaid expansion, but the state lawmakers could drop it from the next budget cycle due in the face of the ACA’s repeal and questionable replacement.
Another state with a lot to lose is California, which expanded Medicaid coverage and established a health insurance exchange for about 1.4 million enrollees, California Healthline reports. Supporters of the ACA pointed to California as proof of the law’s success.
California Insurance Commissioner Dave Jones said the state can’t afford to keep Medicaid expansion and insurance subsidies without federal support. The state risks losing roughly $15 billion in annual funds for the subsidies and Medicaid expansion if the ACA is repealed.
One possibility is that ACA replacement legislation will allow states to modify, rather than eliminate, their programs. That’s what happened in Kentucky, where Republican Gov. Matt Bevin kept Medicaid expansion in place and sought a waiver to transition people away from Medicaid if they became eligible for employer-based insurance, though the state would still cover any lost services.
There is also the possibility that the new administration and the GOP-led Congress will transform Medicaid from an entitlement program into a block grant program — a move Trump and House Speaker Paul Ryan (R-WI) have both endorsed, KHN reports. That would give states more wiggle room in how they run their programs.
The federal government could also impose a per capita cap on spending per Medicaid enrollee, with annual increases in the amount. However, critics warn that the rates could lag behind rising healthcare costs.