We the People: What will health insurance look like under President Trump?

President Donald Trump proclaimed his affection for Republican House Speaker Paul Ryan before his inauguration stating that he is “starting to really, really love Paul” and that he believed they will do “very well together.”

The two have had a rocky relationship with some analysts predicting that Team Trump would campaign to have Ryan removed as speaker after entering office.

They have had differences on policy: Ryan does not support tariffs on imports and wants to “reform” Medicare while Trump talks about “trade wars” and wants to leave Medicare alone. They have both called for the immediate dismantling of the Affordable Care Act or Obamacare.

The pair traded barbs and snubs during the unpredictable 2016 campaign. When interviewed by Charlie Rose, Ryan dismissed the idea of hard feelings. He said, “I’m a big boy with thick skin.” The 10-term representative from Wisconsin has needed one during the past year but it seems that he is holding the more conservative members of the Republican Party together in a coalition while finding a way to plan to work with President Trump.

That means the outline Ryan provided to Rose may very well be the way a Trump-led America will live for the next four years. Ryan shied away from providing too many details but assured listeners that the GOP would “replace” the “failed” ACA with a system of direct subsidies for the pool of people with pre-existing conditions and health savings accounts and “refundable tax credits.”

He failed to explain where the coverage would come from or how enough people would be insured to make a replacement system actuarially sound. Having a subsidy for care when you cannot afford care means nothing to the uninsured. Ryan has said, “I don’t believe a bureaucrat should be in charge of your health care decisions … you should be in charge.” However, when you have no healthcare, that power is small comfort.

He promises reforms to Medicare because the system is broken and will be bankrupt. The “reforms” mentioned provided precious little detail to enlighten citizens as to how “reform” will take away the right to healthcare after a lifetime of work.

Paul Ryan is affable, intelligent and charming, which is frightening when combined with his hardline ideas on issues. He has been rated “A” by the NRA and supported a national cross-state standard for concealed carry of firearms. So if Louisiana passed a law that its citizens can carry firearms concealed anywhere then other states including New York would have to do the same.

He has advocated for veterans be allowed to register unlicensed guns acquired abroad. He has made endorsements of privatization of Social Security on a voluntary basis for younger workers and enthusiastically promoted President Bush’s semi-privatization scheme in 2012.

He told Charlie Rose that he will eliminate Labor Department and EPA regulations and make sure that the U.S. becomes an energy superpower like OPEC. He voted to allow deep sea oil drilling on the Outer Continental Shelf and to bar the EPA from regulating greenhouse gases.

He has voted against bills for enforcing limits on global warming pollution, for tax incentives for conservation and for renewable energy. Later in his interview, he described Russia’s oil industry as unreliable. Why would he push an energy economy as a good model for the U.S. but describe it as a “failed” one for Russia?

President Donald Trump wants Representative Tom Price of Georgia to be his Secretary of Health. Price, a longtime critic of the ACA, has stated, “The purpose of health reform should be to advance accessibility, affordability, quality, responsiveness and innovation,” and that, “None of these are improved by Obamacare.”

In 2015, Price introduced the Empowering Patients First Act which proposed to increase the amount people could contribute to health savings accounts, expand tax-deductible contributions and allow the accounts to pay some primary care fees. The act included a requirement that HHS “provide a grant to each state for high-risk pools or reinsurance pools to subsidize health insurance for high-risk populations and individuals.”

The high-risk health pools would be for people challenged in finding affordable insurance because of pre-existing conditions but it doesn’t assure they would be covered by any insurance.

Prior to enactment of the ACA, many states used high-risk pools to try and accommodate people who otherwise would not be insured due to pre-existing conditions. The Kaiser Family Foundation found that state high-risk pools often required significantly higher premiums and accommodated a small fraction of people who need coverage.

Price has publicly supported Ryan’s call for repealing and replacing the ACA with his “Better Way” plan. The non-partisan Rand Corporation, a think tank, found that “premiums increase even more and enrollment falls further” if the “Better Way” provisions are enacted.

Ryan and Price support the idea of giving Medicare and Medicaid enrollees a fixed amount of money to apply toward health insurance rather than getting any coverage through the government. Professor Christine Eibner, an economist, said that a tax credit to Medicare and Medicaid enrollees would ease the cost burden on the government but redirect it to the consumers.

She said, “The drawback with an approach like this is it puts the risk of increased spending on the enrollee” without increased premiums “taken into account.”

We have a new philosophy driving national policy. Hopefully, it will take into account the needs and desires of all Americans. President Trump and Speaker Ryan should work on sustaining job growth and improving our national infrastructure before expending energy on being able to say they dismantled Obamacare and “reformed” healthcare or expand the rights of gun owners.