Gray Shore: Looking at the ACA in the Era of Trump by Memo Diriker


November 2016 has come and gone. Now, we have a new President and a new faces in the U.S. Congress. The Republicans may have won it all but now, they are facing the daunting task of delivering on their various (costly) promises while simultaneously respecting the conservative values they hold dear. No GOP promise has been repeated as often and as loudly as the one to repeal the Affordable Care Act (ACA), otherwise known as “Obamacare.”

Not surprisingly, Republicans in both the House and Senate have moved rapidly to set in motion the process for repealing the ACA but they seem to have not much of an idea with what to replace it. Every option available to them seems to have a different booby trap attached to it. While the senior leaders of the Republican Party are unanimous in their desire to repeal the ACA, they are most definitely not unified as to what will take its place. Whatever they solution they might be able to craft, they are assured of vigorous opposition from Democrats in Congress and from a very wide range of stakeholder groups throughout the nation.

To make the process even more complicated, the policy direction the new White House wishes to take with the replacement part of Repeal and Replace is not very clear. We are now finding out that some of the staunchest supporters of the new President were not aware that the “Obamacare” they so loudly opposed was the same as the Affordable Care Act that they seem to like quite a bit. The choices are not very good:

Should coverage be denied due to pre-existing conditions? Most Americans oppose this.
Should children over 18 be excluded from policies? Most families like this benefit.
Should the individual tax mandate be removed? Budgetary implications of this are phenomenal.
Should coverage amounts and categories be reduced? Seems to be a No-Win solution.
Should the high risk-pools replace the current policies? This is a bad solution with high costs.
Are Health Savings Accounts the answer? Not for millions who do not earn enough.

Another aspect of the replacement process is that Republicans can only repeal parts of Obamacare that have to do with budget measures. They will need at least eight Democrats in the Senate for replacing part of all of the ACA. The likelihood of Democrats collaborating in the replacement of their signature achievement has got to be pretty low.

Earlier, some GOP senators introduced a bill that would allow states to keep the ACA if they so choose but most Democrats are opposed to this bill that they label “Chaos.” Based on early indications, it is clear that the head winds against replacement will come from all corners, including within the GOP itself. Yes, Republicans want to get rid of the Affordable Care Act, but not all of them are ready to accept the consequences hurting people or adding to the deficit.

Finally, none of the current talk about repealing and replacing the ACA includes the need to reform the way we do healthcare here in the United States. At over $3.3 trillion a year or over $10,000 for each man, woman, and child in this country, we spend at least 50% more on healthcare than the next highest spending country (France) as a percentage of our GDP. Are our health outcomes 50% better? The answer is NO! Among the top 10 industrialized nations, we are dead last in healthcare outcomes. These outcomes include: Quality, Access, Efficiency, Equity, and Wellness. So, what is the one big difference between us and the other nine? Universal healthcare!

Dr. Memo Diriker is the Founding Director of the Business, Economic, and Community Outreach Network (BEACON). BEACON is the premier business and economic research and consulting unit of the Franklin P. Perdue School of Business at Salisbury University. BEACON is home to the award winning Community Visioning, ShoreTRENDS, GraySHORE, ShoreENERGY, GNAppWorks, and Bienvenidos a Delmarva initiatives and a proud partner of the GeoDASH initiative.

Letters to Editor

  1. Muriel Cole says:

    Excellent summary, and thought provoking.

  2. Gren Whitman says:

    How can we end this debate over health care and provide health insurance for all?
    By including everyone who wishes to join in a proven health insurance system — Medicare!

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