Thanksgiving, Post-Election: Three Health Care Talking Points from an Economist

1. I'm not sure what's going to happen to the ACA. Potentially, 22 million Americans could lose health insurance coverage. It seems politically foolish to allow that to happen. That said, the Republicans could allow the Health Insurance Exchanges to unravel by simply changing the penalties involved. The exchange-based system is fairly fragile and easy to destroy. I'm not sure about the Medicaid expansion.

2. Beyond the ACA, Republicans are discussing shifting to block-grants for Medicaid and somehow privatizing or shrinking Medicare. Those are old policy ideas–Republicans have been interested in both for decades. It's dangerous to predict the future, especially after being so incredibly wrong about the election, but I suspect that Republicans will get nowhere on either front. Any potential cut to Medicare is like punching senior citizens in the dentures–it's political suicide. And cuts to federal funding of Medicaid will bring protests from the hospital industry and state politicians.

3. I think it's important to remember that there are two distinct reasons to lose your shit: (1) Republicans now control the government and, (2) Donald Trump is President. Any Republican President would roll back the ACA, limit access to abortion, nominate conservative judges to the Supreme Court, limit environmental controls, and so on.

But there are separate reasons to be concerned about Donald Trump: he has promised to deport millions of people, he has proposed unconstitutional restrictions on Muslims, he has promised to encourage the military to torture prisoners, he hates the press and seems to be in favor of restrictions on the first amendment, the KKK endorsed him, and so on. These are all issues unique to him. And so we should all be freaking out. When you go back home and sit across from your Trump-loving relatives, you might consider smacking them in the face with the turkey.

by Tal Gross, PhD, Assistant Professor in the Department of Health Policy and Management