As we look to 2017, we must understand that many of the governmental medical and retirement plans may be changed by the incoming Trump administration. I am not going to recite how the 2016 presidential election occurred, rather I want to focus on the IMPACT of the proposed Republican changes to Medicare, Social Security, and Obamacare. It is important to realize that the Republicans have been touting these changes for many years. Now that they control the Congress, the Executive Branch and many State houses, we should assume they will implement these changes. What do these changes mean for us in Hawaii, as State and County employees preparing for, or already living in, retirement?
Over the next several weekly sessions, we will look at the proposed changes and to to figure out what it means for us.
Obamacare: The Affordable Care Act (referred to as Obamacare) took a long and tortuous journey to its birth a few years ago. Since then, the Republicans have pushed the idea of revoking and replacing the plan. All that we already know.
Now that they are in charge, the Republicans will have the opportunity to do just that- revoke and replace it. Except that there are two parts of the present plan most politicians agree they want to keep: the provision that younger people can remain on their parents medical plan and, most importantly, that people with "pre existing health conditions" can not be separately cost rated or denied coverage. Pre-existing conditions would be diabetes, severe heart problems, cancers, etc. Pre existing conditions determinations are used within the insurance industry to limit or deny coverage if, at the time of enrollment, the person has an illness or health condition that will require immediate high cost care. Taking on large numbers of persons with a pre-exisiting condition can financially ruin an insurance carrier, forcing the carrier to raise costs across the board. In the worst case scenario, too many examples of pre-existing conditions will force the carrier to withdraw from the market place, cancelling the insurance for all its policy holders.
Providing coverage for persons with pre-existing conditions requires more premium from healthy people who rarely use their medical coverage. This is why the healthy-young are required to buy health insurance under the Individual Mandate provision of the ACA. And, this is one ACA provision that many people hate, and one key ACA provision Republicans want to kill off. Understandably, when rising health care costs fall on those that don't use their plan, and they are forced to buy the coverage, resentment follows.
The problem is that removing the Individual Mandate means that insurance carriers can not provide care to people with pre-existing conditions. There is not enough money to do so.
The current (Dec 2016) talking point is that the Republicans will kill off Obamacare in early 2017, but replace it in a few years. This approach may not sit well with insurance carriers who cannot accurately gauge costs over the next few years. We may see carriers leave the market, and therefore terminating medical coverage for thousands if not millions of people.