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On the verge of…Trumpcare Rethinking the healthcare system

corresponding

Paola Arosio 
Freelance journalist

Abstract

After endlessly repeating that he would have wiped away the Affordable Care Act (ACA) the very moment he would have taken office as the new US President, Trump had soon after put aside such a drastic intention and started looking into alternative strategies. 
Two considerations probably led Trump to change his approach to the health system reform. 
The first is the poll by NBC News and the Wall Street Journal that has shown that Americans are starting to warm up to Obamacare and that three quarters of the people surveyed think that repealing the Affordable Care Act is wrong without a new valid healthcare system to replace it. The second is that the healthcare system that former President Obama had launched has been able to broaden health insurance coverage over an additional 21 million Americans, mostly low-income people. 
Although, compared to the initial intentions, Trump had already stopped, the drubbing came on March 24 when, against his will, was forced to withdraw the health bill, after it failed to gain enough support to pass in Congress. House Speaker Paul Ryan said he and Trump agreed to pull the vote, after it became apparent it would not get the minimum of 215 Republican votes needed. «We have to let Obamacare go its own way for a little while», Trump said. Now the Republicans are trying to improve their bill. 
Meantime, below we compare the ACA to the principles Trumpcare is based on.


MEDICAID FUNDING TO BE BLOCK-GRANTED

The ACA sought to expand the Medicaid program nationwide to cover more uninsured, low-income families. To achieve this, Obama devised Medicaid to be funded jointly by the federal government and the states. As it stands, the federal government matches Medicaid funding on a state-by-state basis and the contribution is at least dollar for dollar, with poorer states receiving more funding for Medicaid services so that they can expand Medicaid services.  Trumpcare is proposing an alternative to the current financing system, supported especially by Trump’s head of Health and Human Services department, Mr. Tom Price, who wants to establish a block-grant programme. With Trumpcare, states would be allotted a set amount of money each year to run their individual Medicaid programs, which however would be detrimental to single-state Medicaid expansion plans. 

FEWER SUBSIDIES

The ACA provides subsidies to low-income families to help them buy private insurance policies. Price doesn’t like this idea as well and seeks to replace subsidies with flat-tax credits based on age, not income. Tough criticism ...




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