We now know that Rep. Tom Price has been tapped by Pres. Elect Trump to head the Department of Health and Human Services. This answers, in part, one of the questions raised by a PHS 795 student in commenting on a Health Affairs blog piece on the future of the ACA:
I’d like to point out, as the author does too, that Trump never actually refers to The Patient Protection and Affordable Care Act, just “Obamacare.” I think the fact that he doesn’t (or can’t?) actually name the legislation is telling. The ability to talk about legislation in a specific and clear way is important, and will have implications for what happens next. If President Elect Trump can’t point to specific provisions to repeal either he’ll be unsuccessful in repealing anything, or he’ll create a mess of our health care system by derailing and defunding all of the new structures, federal offices, funding streams, and policy mechanisms that PPACA put in place. I think this piece does an excellent job of outlining scenarios and showing that political leadership really matters. It really matters who control Congress. It matters who President Trump selects as his Sec. of Health and Human Services (as well as other cabinet positions). Trump will almost certainly have enormous, and probably painful, impacts on the health system. And while interesting as a policy experiment, these changes will affect peoples’ lives in ways we probably can’t yet understand.
http://healthaffairs.org/blog/2016/11/09/day-one-and-beyond-what-trumps-election-means-for-the-aca/
The Fantasy Equation 
This is a good find, and Jost does an excellent job at summarizing the to-be Trump Administration’s potential impact on the ACA and healthcare as a whole.
What stuck out to me was insurers’ lack of trust in the ACA health insurance marketplace and how that trust may deplete even further. As Jost noted, it’s fair to say that insurers will leave the market or raise prices if the new administration fails to enforce the program and prepares to dismantle it. However, there are uncertainties regarding (1) who this will impact most, and (2) how the administration will respond.
Regarding the range of impact, I wonder if this will create geographic pockets of marketplace deserts. States have the choice to oversee their ACA marketplaces, with some states having more robust markets than others. Likewise, some states have struggled to operate the exchanges (Vermont Health Connect is a prime example). If insurers pull out of marketplaces that are already struggling, we may experience state-specific influxes of uninsured Americans. This not only become a federal issue (insurers losing trust in the federal government), but it also becomes a state-level problem (incentivizing insurers to stay in a dwindling market in order to protect their residents’ coverage).
As for the administration’s response, I’m totally lost as far as what Trump wants to do, and I think a lot of other people feel the same way. In his 60 Minutes interview, Trump promised a smooth transition in coverage so that no one would lose insurance, but that promise is far-fetched. As we just discussed, the existence of a Trump Administration will be enough to drive away insurers from the marketplace. So, we have to ask ourselves the question, “What do we do with the prospective uninsured who do not qualify for public insurance?”
Last point: I would be careful to conflate Trump’s use of “Obamacare” (or rather his non-use of “The Affordable Care Act”) as evidence of misunderstanding the law. I would guess that this is more of a rhetorical tactic to arouse public disdain of the law. I wouldn’t be surprised if most ACA opponents exclusively referred to the law as “Obamacare” when they’re in the public spotlight.
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One clue as to what may happen next can be found in Avik Roy’s blog – The Apothecary. See http://www.forbes.com/sites/theapothecary/#31e78be63809. He’s a common ACA critic and has some reasonable, detailed ideas on levels to push/pull to reform the current delivery system.
And here – http://www.vox.com/policy-and-politics/2016/11/29/13778622/price-trump-medicaid-block-grants a good analysis on potential impacts of Tom Price’s policy priorities.
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