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The Road to a New Affordable Care Act: “Trumpcare” Not "Obamacare"


LEANING RIGHT--If you hate Republicans more than you love the healthcare of Americans, perhaps this piece isn't for you.  If you hate Democrats more than you love the healthcare of Americans, perhaps this piece isn't for you, either. 

The singular and permanent benefit of "Obamacare", a.k.a. "The Affordable Care Act" is that something HAD to be done, and there's no going back on that. The outgoing President merits any and all credit for that.  

Now it's up to the incoming President and the GOP-led Congress to determine that the successor to "Obamacare" will be a more health-focused, more fiscally-sound, and less politically-driven plan...and it's hoped that Democratic critiques and recommendations will be listened to and addressed appropriately.  

The replacement to "Obamacare" MUST be bipartisan to ensure that health care access and quality will be improved in the years to come. 

Which is why the so-called Affordable Care Act, a.k.a., "Obamacare" had such a problematic implementation, and an almost inevitable death that would inevitably have arrived sooner or later. The establishment of "winners" and "losers", the jumps in premiums and deductibles, and the health plans and physicians no longer accepting ACA patients...all pointed to something that just didn't add up. 

The goal was worthy, but when the majority of those most strongly advocating for the Affordable Care Act were NOT on any of the ACA-required plans there was something wrong.  It's the old liberal cariacature of treating the general population like lower lifeforms--as in "yes, I have my old pre-ACA plan and I love it, but this new and very different plan is good enough for the rest of you". 

Those foaming at the mouth and defending the ACA were too often not impacted by either the ACA or its repeal...and their patting the heads of those shrieking about the ACA's negative personal and national economic impacts were as condescending and deferential as...as... 

...as those who deferentially and condescendingly patted the heads of those unable to access health insurance and affordable care prior to the passage of the ACA. 

So now we have an incoming President and Congress who have already taken measures to defund and unravel an ACA that would have, sooner or later, died of its own accord despite its good intentions. 

A first-rate, must-read article ("The End of Obamacare") by Jonathan Oberlander, PhD in the January 5, 2017 New England Journal of Medicine does a first-rate job of analyzing how the ACA's unpopularity led to its upcoming demise. 

Dr. Oberlander has this excellent "money quote": 

"Obamacare’s vulnerability reflects not only the 2016 election results, but also its shallow political roots. The ACA has achieved much, including a large reduction in the uninsured population. Still, it lacks strong public support and an organized beneficiary lobby, has encountered significant problems in its implementation, and has been enveloped by an environment of hyperpartisanship. If the ACA were more popular and covered a more politically sympathetic or influential population, if its insurance exchanges were operating more successfully and had higher enrollment, and if Democrats and Republicans were not so ideologically polarized and locked in a power struggle, then an incoming GOP administration would probably be talking about reforming rather than dismantling Obamacare. 

“The Trump administration can do much to undercut the ACA. The insurance exchanges, buffeted in many states by high premium increases, sicker-than-expected risk pools, and insurer withdrawals, require stabilization; simply by doing nothing the GOP could damage them." 

So while some Republicans and Independents (and even Democrats) are cheering the end of "Obamacare", the work is only just beginning to replace the ACA with something more sustainable. 

And it's the GOP and incoming President-Elect Trump who have the burden--and make no mistake about it, it's a huge (YUGE?) burden--to replace and "trump" the ACA with something better. 

Arthur Caplan, PhD writes another excellent, must-read article ("Healthcare and Healthcare Ethics in the Trump Era") for Medscape on the challenges of replacing "Obamacare". 

Dr. Caplan points out that "Even though Trump has said that he will repeal and replace it, I suspect that certain features of Obamacare are so well embedded that they are going to be very tough to get rid of without politically uncomfortable complaints." 

The good news, for those who may not remember, is that Trump himself stated he would not "let people die in the streets", and caught both heat and political support among Republicans (and Independents, and even some Democrats, who switched party affiliation during the GOP primary races) as Trump fought off over a dozen GOP presidential contenders. 

Trump stated that he DOES favor an end to pre-existing conditions, and DOES favor the allowance of adult children to stay on their parents' health plans until the age of 26.  

The era of a lack of access to affordable health care is over. 

The era of winners and losers under a top-down, government-imposed and taxing ACA is over...or at least will be soon. 

It will be up to President-Elect Trump and the new 2017-2018 Congress, in THIS session, to also end a few new eras: 

1) An end to unaffordable prescription drug costs. 

2) An end to high-deductible, limited-access policies that force individuals and families to pay for benefits that have little to no relevance to their personal needs. 

3) An end to states suffering from limited plans and health insurers, and a beginning to more interstate options to allow competition and encourage lower costs of health care. 

4) An end to federally-mandated health plans (effectively tax increases, as stated by Supreme Court Chief Justice Roberts in his support for the Constitutional vetting of the ACA) that had unsustainable premium hikes and penalties for not joining. 

5) An end to fiscally strapping businesses (and perhaps a beginning to enticing and rewarding businesses) to hire full-time workers with career-jobs and benefits. 

6) An end to forcing those with cancer or debilitating diseases into poverty, and the establishment of high-risk pools so that society in general can pay for those who are incapacitated, and to reward innovative new medical technologies to further the science of medicine. 

7) An end to the decades-long debate of how to create a fiscally-sound national health policy that benefits all Americans, and is not merely politically-driven, and finally has the backing of the majority of American health care professionals and advocacy groups.


(Kenneth S. Alpern, M.D. is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties.  He is also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He is co-chair of the CD11Transportation Advisory Committee and chairs the nonprofit Transit Coalition, and can be reached at  [email protected]. He also co-chairs the grassroots Friends of the Green Line at www.fogl.us. The views expressed in this article are solely those of Dr. Alpern.)




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