Trump Wins Presidency and Chance to Dump ACA

November 09, 2016

American voters tonight set political history on its head by electing Republican Donald Trump to be their next president.

Now the real-estate magnate and reality-TV star who told raucous crowds that he would "Make America Great Again" will try to fulfil his promise to dismantle President Barack Obama's signature legislation — the Affordable Care Act (ACA). Trump proposes to replace it with free-market solutions to the nation's healthcare problems, solutions that Republicans have championed for years.

A political novice, Trump bested 16 other Republican contenders in the primaries and then defeated Democrat Hillary Clinton even though his braggadocio, insults, and recorded statements about groping women would have easily doomed any other candidate. But voters ultimately preferred Trump to Clinton, dogged by a quarter century of her own political controversies, including thousands of missing government emails, and the sexual scandals of her husband and former president Bill Clinton.

The Associated Press declared Trump the winner at 2:29 am EST on November 9 after he had garnered 279 electoral votes — nine more than the 270 needed to triumph — with more electoral votes still outstanding. At last count, Trump retained all of the states that went for Romney in 2012 and flipped formerly blue states such as Florida, Iowa, Ohio, and Pennsylvania into the red column as well. He was garnering about 48% of the popular vote compared with 47% for Clinton, according to The New York Times.

Whether Trump can translate his campaign promises into legislative reality, of course, depends on Congress. The election results suggest that Capitol Hill gridlock could extend into 2017 unless the author of The Art of the Deal masters the art of the political compromise. Democrats were losing their bid to retake control of the Senate but were expected to gain at least one seat, bringing their total to 47, which includes two seats held by independents who caucus with them. That strengthens their ability to filibuster Republican legislation. Republicans preserved their majority in the House, although it is shaping up to be smaller.

"We Must Make Sure No One Slips Through the Cracks"

In Obama's successful reelection 4 years ago, the economy and jobs weighed on voters' minds more than anything else. In 2016, those concerns took second place to the candidates' personal characteristics, according to a tracking poll conducted last month by the Kaiser Family Foundation (KFF).

Healthcare ranked low on the list of issues of utmost importance to voters in 2016, the KFF survey revealed, and "Obamacare" ranked even lower. When asked what should be a top healthcare priority for the next president and Congress, respondents put these three first — ensuring that high-cost drugs for chronic conditions such as hepatitis and cancer become affordable (74%), lowering prescription drug costs in general (63%), and making sure health plans have enough physicians and hospitals in their networks (57%). Only 37% said repealing the ACA should be the first order of business. And in another set of questions, more respondents said the ACA should be preserved as-is or even expanded (49%) rather than scaled back or junked (41%).

Most of Trump's healthcare pronouncements have focused on the ACA, which he wants Congress to repeal in its entirety. He nevertheless has publicly advocated for healthcare that is more accessible, affordable, and of higher quality. "We must...make sure that no one slips through the cracks simply because they cannot afford insurance," states his campaign website.

One of his most touted prescriptions for healthcare is allowing insurers to sell their policies across state lines. The policy is intended to promote competition and reduce premiums. Two other fixes are allowing individuals to use pretax dollars to purchase coverage and to open health savings accounts, which Trump said would appeal to young healthy Americans who can afford high-deductible insurance plans.

Trump vows to improve Medicaid by contributing federal dollars to state programs in the form of block grants. Like other Republicans, he contends that block grants will give states their rightful say-so in how to spend the money. At the same time, Trump says that the jobs created during his administration will lessen public dependence on Medicaid as well as the Childrens Health Insurance Program.

In a nod toward free-market consumerism, Trump wants to require physicians and hospitals to be transparent about what they charge so that patients can shop for the best prices. Similarly, Trump proposes to give Americans the option to import less expensive drugs from other nations as long as they are safe and dependable.

How much Trump can accomplish, again, will depend on whether Congressional gridlock persists or breaks up. However, the RAND Corporation determined that if Trump's key healthcare proposals were enacted, an estimated 25 million people would lose coverage and the federal government would lose up to $40 billion in 2018.

"Trumpcare" could end up being as contentious as Obamacare.

Follow Robert Lowes on Twitter @LowesRobert

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