HEALTH CARE/Joan Retsinas

Deflecting the Trumpercar

Our President is playing bumpercar, careening from one executive order to another. In the path: European allies, Middle Eastern enemies, refugees, environmentalists, public schools, and, not surprisingly, the entire health care industry. Medicaid, Medicare, the Affordable Care Act – all teeter before the looming Trumpercar.

How to dodge it? Some states are trying.

1) Scream “Stop. Wait.”

A few Republican Governors have screamed “Stop. Wait.” to the “repeal-Obamacare” momentum. Thirty-one states expanded Medicaid under Obamacare – 20 of them with Republican governors. Those governors fear the Trumpercar’s path. The Medicaid expansion brought millions of people onto the insurance rolls, guaranteed hospitals an end to the days of uncompensated and charity care. Gov. John Kasich, for instance, doesn’t want 700,000 Ohio residents dropped; Gov. Rick Snyder doesn’t want 640,000 Michigan residents dropped. In Ohio, the Medicaid expansion is credited with lowering Ohio’s uninsured rate from 36.1% in 2008 to 14.1% in 2015, the lowest ever.

Admittedly, Candidate Trump carried both states; but residents have yet to feel the force of Trumpercar. In fact, the President, driving the legislative repeal, may not recognize the impact, or may not care. Running for President, John Kasich defended his decision to expand Medicaid, explaining that we would be judged by what we did for the poor. (Spiritually, that might be the criterion, politically it wasn’t.) As for the members of Congress eager to slash Medicaid spending, they live in the District of Columbia. While they may visit their home states to raise money, they don’t connect daily with residents. Governors, on the other hand, meet the people who will lose their insurance. Not surprisingly, these Governors want to retard the Trumpercar.

Congress may well ax the “mandate” that forces citizens to buy health insurance. Conservatives opposed it on ideological grounds; Candidate Trump promised to repeal it. Massachusetts Gov. Charley Baker, a Republican, however, has proposed a state mandate on employers. From a health-care vantage, Gov. Baker is a Republican anomaly. He inherited the Massachusetts plan, pushed through by another Republican, his predecessor, Mitt Romney (who underplayed this plan in his 2012 campaign for president). Today Massachusetts boasts the highest insured rate in the nation – 96.8% But a swathe of employers have dumped their employees onto the state rolls. Today Medicaid insures 28% of the state’s population. Gov. Baker proposes to reinstate the “employer mandate” originally passed as part of “the Romney plan.”

Under the “Romney plan,” employers who did not insure their employees paid $295 per employee. The Affordable Care Act nixed that state rule. Gov. Baker, looking ahead to the repeal of the Affordable Care Act, has proposed his own mandate in the 2018 budget: employers with more than 10 employees who do not provide health insurance will pay a $2,000 per employee fine. The “individual mandate” may well disappear. A mandate on employers, however, might help thousands of Massachusetts residents stay insured.

3) Take one step toward the “public option.”

Minnesota Gov. Mark Dayton, a Democrat, wants to take that step. He recognized the crucial flaw in the “individual market”: costs are too expensive for many enrollees. Indeed, soaring premiums nationally fueled the “repeal” fervor. In Minnesota, premiums for this market rose more than 50% in a year. As a short-term response, Gov. Dayton proposed to spend $300 million to pare 2017 premiums by 25 percent for about 125,000 Minnesotans. More radically, he proposed a “public option” for residents seeking insurance. Currently, MinnesotaCare subsidizes insurance for 100,000 residents (income ceiling: $49,000 for a family of four).

The governor would open MinnesotaCare to any resident willing to pay the full cost. The premiums will be steep; but since the overhead for the nonprofit MinnesotaCare is lower than for a private insurer, plus the pool is large, the premiums would be lower than enrollees would find on the private market. That public option has always made sense. President Obama considered it, but abandoned it when critics, egged on by ideologues as well as private insurers, derided it as one step towards national health insurance. Candidate Trump lambasted it.

Gov. Dayton’s solution is pragmatic, but, in this political climate, probably quixotic.

In the next four years, more states will be dodging the Trumpercar.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, March 15, 2017

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