Trump's healthcare plan aims to repeal Obamacare and replace it with a system that allows cross-state insurance sales, health savings accounts, and Medicaid block grants to states. Repealing Obamacare could cause 22 million to lose coverage. Trump now says he wants to keep some aspects like coverage for preexisting conditions. The plan is evolving to include high-risk pools and language against abortion funding. Implementation faces challenges around insuring those with preexisting conditions and limiting coverage losses.

1. TRUMP TRAIN
HEALTHCARE
Blurry Tracks
Storm Van Wey – PharmD Candidate 2017, Butler University

2. Trump Campaign Position on
Healthcare Reform1
1. Complete repeal of Obamacare
2. Allow sale of health insurance across state lines
3. Allow individuals to deduct health insurance premium payments from tax
returns
4. Increase use of Health Savings Accounts
5. Price transparency from all healthcare providers
6. Block-grant funding of state Medicaid programs
7. Allow (re)importation of medications to US

3. HOW IT’S
PLAYING OUT
Reaching Right

4. Repeal of Obamacare
■ If the ACA is repealed > 22 million individuals will be uninsured2
– ~ 10 million individuals bought their insurance through state marketplaces
which would no longer exist
– Massive loss of customers for insurance companies
■ > 100,000 people enrolled via the online marketplace on November 9, 2016, the
day after the election2,3
– Largest enrollment day this season which started November 13
■ Complete repeal is highly unlikely to occur due to disruption to system4

5. Alteration of Obamacare
■ “The Administration recognizes that problems with the US healthcare system did
not begin with – and will not end with – the repeal of the ACA”5
■ Trump is now “trying to keep” two key aspects of the ACA6
1. Children allowed to remain on parents’ insurance until 26 years old
2. Forbidding insurance companies from denying coverage to those with
preexisting medical conditions
■ These cannot be removed via budget reconciliation2
– Though Trump claims he likes them7

6. Reconciliation2
■ Obama vetoed a bill passed by both the Senate & the House that:
– Eliminated expansion of Medicaid to those near and below the poverty line
– Eliminated subsidies for the middle-class to buy their own insurance on the
marketplace
– Eliminated tax penalties for the uninsured meant to encourage everyone to
maintain insurance
– Eliminated taxes meant to fund these programs
■ Would’ve kicked in after 2 years
■ Maybe why Trump’s new language is looking similar to this?

7. Health Insurance Across State Lines8
■ Goal is to increase competition
■ Many large insurance agencies operate in multiple states already
■ Requires insurers to negotiate with new hospitals, health networks, and
providers
■ Could result in young, healthy people enrolling in certain cheaper plans
– Results in higher-cost coverage for those with complicated disease states
■ May also result in states dropping their requirements for healthcare plans to very
minimal levels
– States that require more robust coverage may no longer be able to demand
it
■ This will likely be explored and is listed on Trump’s transition website
– Also discusses state “flexibility” in administering Medicaid

8. Allow Individuals to Deduct Insurance
from Taxes
■ Employers are currently able to do this, but individuals are not9
■ Fears that it could weaken employer-based insurance6
■ Likely due to restructure of tax laws typical of Republicans and aligns with the
reconciliation bill discussed previously

9. Increase Use of Health Savings
Accounts8
■ Tax exempt accounts that would become part of individuals’ estates and could
be passed on with no death penalty
■ Meant to be used with high-deductible health plans
■ Bad for hospitals, who are stuck when people don’t pay bills
– Hospitals also agreed to get less money from the government since more
people are insured under the ACA
– Likely to see use of emergency rooms for primary care of those uninsured
■ Note: Speaker Paul Ryan is a proponent of HSA’s
■ Key point in both campaign & transition sites1,9

10. Price Transparency from All
Healthcare Providers
■ Very unclear how this is to be done
■ No further elaboration on this topic at this time

11. Block-Grant Funding of Medicaid
■ Granting states a set amount of money that they then determine how to use9
– Back to the “flexibility” aspect listed on transition website
■ Questions that have been raised:10
– How will this amount be set?
– How will it be adjusted? (Population growth, economy, cost of care, etc.)
■ Again, Speaker Paul Ryan is in support of these8

12. Prescription Drugs Pricing &
(re)Importation
■ This was something Trump supported on the campaign1
■ It is mysteriously missing from the transition website9
■ No mention in any interview
■ Biotech & Pharma stocks have surged8,11,12,13
– Maybe premature, if people lose coverage, less people are predicted to buy
medication, especially high-cost
■ Possibly too liberal of an idea?

13. Trump Transition Position on
Healthcare Reform – New Language9
■ High-risk pools
■ Protect individual conscience in healthcare
■ Anti-abortion language
■ Protection of those who are defenseless and/or disabled
■ Reform FDA to expedite the approval of innovative treatments and products
■ Modernize Medicare
■ Maximum flexibility for states to determine how to provide Medicaid

14. High-Risk Pools8
■ Goal: secure coverage for those with preexisting medical conditions
■ Used by some states for 35 years
■ Issues:
– Have typically only covered small groups of people
– Associated with high premiums
– Limited number of services

15. Abortion and Birth Control
■ Trump’s stance on abortion has been somewhat ambiguous now has picked up
traditional right tones6
■ Pence is acting as Trump’s “liaison” to Congress7
– Pence and Ryan are “friends”
■ Both Pence and Ryan have taken traditional, conservative approaches to birth
control and abortion6,7,14
– Ryan has refused to state whether the alterations will remove funding for
birth control14
■ “Protect innocent human life from conception to natural death…”9
■ Trump has sent a letter to “pro-life leaders” during campaign promising6
– Nomination of Supreme court justices who oppose abortion
– Remove funding for Planned Parenthood
– Hyde Amendment – limit federal funding for abortion

16. FDA Restructuring
■ “Advance research and development in healthcare”9
■ “… Greater focus on the need of patients for new & innovative medical
products.”9
■ 21st Century Cures Act may gain favor11
– Backed by Industry
– Faster routes for development
– $2 billion x 5 years to create NIH innovation fund
– $550 million to the FDA over 5 years
■ “Deregulation and reducing of safety standards” are biggest concern13

17. Medicare & Medicaid
Medicare
■ “Modernizing”
■ Very few specifics6
■ Expansion of Medicare
Advantage8
■ Managed Care8
– Push cost onto enrollees
Medicaid10
■ Copayments &/or work
requirements
■ Proof of citizen ship & state
residency
■ Premiums

18. Sources Cited
1. Healthcare Reform Paper. Donald J. Trump presidential campaign website. https://assets.donaldjtrump.com/HCReformPaper.pdf. Accessed November 9,, 2016.
2. Abelson R. Donald Trump says he may keep parts of Obama health care act. The New York Times. Business Day. http://www.nytimes.com/2016/11/12/business/insurers-unprepared-for-obamacare-repeal.html. Published
November 11, 2016. Accessed November 14, 2016.
3. Ferris S. ObamaCare sign-ups surge post-election. The Hill. Policy. http://thehill.com/policy/healthcare/305419-obamacare-signups-surge-post-election. Published November 10, 2016. Accessed November 11, 2016.
4. Rosenthal M. The politics of health care reform. Pharmacy Practice News. Policy. http://www.pharmacypracticenews.com/Policy/Article/11-16/The-Politics-of-Health-Care-Reform/38218/ses=ogst?enl=true.Published November 8,
2016. Accessed November 10, 2016.
5. Tracer Z, Kapur S. Trump outlines health plan from Obamacare repeal to abortion. Bloomberg. Politics. http://www.bloomberg.com/news/articles/2016-11-10/trump-outlines-health-care-plan-including-repealing-obamacare.
Published November 10, 2016. Accessed November 14, 2016.
6. Goldstein A. Trump health-care agenda evolves toward core Republican thinking. The Washington Post. Health & Science. https://www.washingtonpost.com/national/health-science/trump-health-care-agenda-evolves-toward-
core-republican-thinking/2016/11/11/a31858c4-a828-11e6-8fc0-7be8f848c492_story.html. Published November 11, 2016. Accessed November 11, 2016.
7. Langley M, Baker G. Donald Trump, in exclusive interview, tells WSJ he is willing to keep parts of Obama health law. The Wall Street Journal. Politics: Election 2016. http://www.wsj.com/articles/donald-trump-willing-to-keep-
parts-of-health-law-1478895339. Published November 11, 2016. Accessed November 14, 2016.
8. Court E. Here’s what we know so far about President-elect Trump’s post-Obamacare health plan. MarketWatch. Health Care. http://www.marketwatch.com/story/heres-what-we-know-so-far-about-president-elect-trumps-post-
obamacare-health-plan-2016-11-14. Published November 15, 2016. Accessed November 15, 2016.
9. Healthcare. President Elect Donald J. Trump transition website. https://www.greatagain.gov/policy/healthcare.html. Accessed November 11, 2016.
10. Pear R. Expect Medicaid to change, but not shrivel, under Donald Trump. The New York Times. Politics. http://www.nytimes.com/2016/11/16/us/politics/trump-medicaid-health-care.html. Published November 15, 2016. Accessed
November 16, 2016.
11. Adams B. Biopharma stocks jump as Americans vote for Trump. FierceBiotech. Biotech. http://www.fiercebiotech.com/biotech/markets-slump-as-americans-vote-for-trump. Published November 9, 2016. Accessed November 11,
2016.
12. Staton T. Pharma loves free trade. How will it get along with a protectionist President Trump? FiercePharma. Pharma. http://www.fiercepharma.com/pharma/pharma-loves-free-trade-how-will-it-get-along-a-protectionist-president-
trump. Published November 9, 2016. Accessed November 11, 2016.
13. Johnson C. Trump just dropped a big hint to the pharmaceutical industry. The Washington Post. Wonkblog. https://www.washingtonpost.com/news/wonk/wp/2016/11/14/trump-just-dropped-a-big-hint-to-the-pharmaceutical-
industry/. Published November 14, 2016. Accessed November 15, 2016.
14. Silverstein J. Paul Ryan won’t say if Trump healthcare will cover birth control. New York Daily News. Politics. http://www.nydailynews.com/news/politics/paul-ryan-won-trump-health-care-cover-birth-control-article-1.2871410.
Published November 13, 2016. Accessed November 15, 2016.