Trump and the Affordable Care Act

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President-elect Donald Trump has vowed to repeal and replace the Affordable Care Act. Swapna Reddy, clinical assistant professor in Arizona State University’s School for the Science of Health Care Delivery, we’ll talk about what happens if the ACA is repealed and replaced. She will also discuss plans Trump’s plans for state Medicaid programs.

TED SIMONS: COMING UP NEXT ON "ARIZONA HORIZON," WE'LL DISCUSS THE POSSIBLE IMPACT OF THE TRUMP PRESIDENCY ON HEALTH CARE POLICY. ALSO TONIGHT, WE WILL HEAR ABOUT THE AMERICAN INDIAN AWARDS OF EXCELLENCE, AND FORMER HOUSING SECRETARY HENRY CISNEROS TALKS ABOUT IMMIGRATION ISSUES. THOSE STORIES NEXT ON "ARIZONA HORIZON."
ANNOUNCER: "ARIZONA HORIZON" IS MADE POSSIBLE BY CONTRIBUTIONS FROM THE FRIENDS OF ARIZONA PBS, MEMBERS OF YOUR PBS STATION. THANK YOU.
TED SIMONS: GOOD EVENING AND WELCOME TO ARIZONA HORIZON. I AM TED SIMONS. ARIZONA SECURITY DIRECTOR TIM JEFFRIES ALLEGEDLY PURCHASED ALCOHOL FOR DES STAFFERS DURING WORK HOURS. THAT'S ACCORDING TO TAYLOR WHO SAID HE BOUGHT ALCOHOL AND SOFT DRINKS FOR A WORKDAY OFFICE PARTY. IT WAS TO CELEBRATE EMPLOYEES AGREEING FOR BONUSES IN EXCHANGE FOR CHANGING THEIR EMPLOYMENT STATUS SO THEY COULD BE FIRED AT WILL. THEY THE DRINKING OCCURRED OFF HOURS AND NOT ON STATE TIME. AND THE HOMELESS -- UNEMPLOYMENT RATE FELL TO 5.2% DOWN FROM 5.5% THE PREVIOUS MONTH. A DEPARTMENT OF ADMINISTRATION REPORTS THAT ARIZONA GAINED 28,000 NONFARM JOBS IN OCTOBER, A COUPLE THOUSAND JOBS ABOVE THE POSTRECESSION AVERAGE GAIN. 10-11 ECONOMIC SECTORS ADDED JOBS LED BY BUSINESS AND PROFESSIONAL SECTORS. NO SECTOR LOST JOBS. PRESIDENT-ELECT DONALD TRUMP HAS VOWED TO REPEAL AND REPLACE THE AFFORDABLE CARE ACT AND PRO-POKING CHANGES TO MEDICAID. HERE TO TALK ABOUT POSSIBLE CHANGES IN HEALTH CARE POSSIBLE IS SWAPNA REDDY ASSISTANT PROFESSOR AT ARIZONA STATE UNIVERSITY. THANKS FOR JOINING US.
SWAPNA REDDY: THANKS FOR HAVING ME.
TED SIMONS: WHAT IS THE VIEW OF THE AFFORDABLE TRUMP CARE ACT UNDER A TRUMP PRESIDENCY?
SWAPNA REDDY: WE'RE NOT 100% SURE IS THE QUICK ANSWER. PRESIDENT-ELECT TRUMP HAS VOWED TO REPEAL AND REPLACE THE ACA. THAT WAS A MAJOR CAMPAIGN PROMISE. WE KNOW THAT'S NOT AS QUITE AS AMP SIZE IT SOUNDS AND HE'S FINDING AS HE'S REALIZING THAT CAMPAIGN PROMISES ARE EASIER THAN THE BUSINESS OF GOVERNING. WE KNOW THAT RECENTLY HE HAD A MEETING WITH PRESIDENT OBAMA AND ON "60 MINUTES" WE HEARD HE'S INTERESTED SIMONS IN KEEPING CERTAIN PROVISIONS OF THE ACA. THE QUICK ANSWER IS WE'RE NOT 100% SURE. RIGHT NOW, WE KNOW WHAT IS POSSIBLE VERSUS WHAT IS LIKELY NOT WHAT IS GOING TO HAPPEN.
TED SIMONS: IS THERE A LIKELY SCENARIO AS TO WHAT WOULD BE REPEALED AND WHAT WOULD BE REPLACED?
SWAPNA REDDY: HE'S INDICATED SIMONS THAT HE IS A FAN OF TWO REALLY POPULAR PROVISIONS. ONE IS FOR YOUNG PEOPLE TO BE ABLE TO STAY ON THEIR PARENT'S COVERAGE UNTIL THEY'RE 26 YEARS OLD AND ANOTHER IS TO NOT DISCRIMINATE BASED ON PREEXISTING CONDITIONS. WHAT MAKES IT A LITTLE BIT TOUGH IS THOSE ARE TWO OF MANY PROVISIONS UNDER THE ACA. THE AFFORDABLE CARE ACT IS A HUGE PIECE OF UMBRELLA LEGISLATION AND HAS TENTACLES IN ALL KINDS OF DIFFERENT POLICIES. SO IT'S NOT REALLY A SINGLE PIECE OF LEGISLATION YOU CAN REPEAL BECAUSE IT'S INVOLVED IN SO MANY OTHER THINGS. ONE THING THAT WE KNOW IS WE DON'T HAVE A SUPER MAJORITY. THE REPUBLICANS DON'T HAVE A SUPER MAJORITY IN CONGRESS. IT'S UNLIKELY THEY WOULD BE ABLE TO HAVE A FLAT REPEAL OF THE ACA. WHAT IS A LITTLE BIT MORE LIKELY, THEY MIGHT BE ABLE TO GET IN KIND OF THROUGH THE BACK DOOR, THROUGH A BUDGETARY RECONCILIATION PROCESS.
TED SIMONS: I WAS GOING TO SAY.
SWAPNA REDDY: YEAH. THAT'S WHAT WE HAVE A BLUEPRINT FOR THAT FROM THAT LAST YEAR. THE HOUSE AND SENATE WERE ABLE TO PASS A BUDGET RECONCILIATION BILL THAT WOULD HAVE LARGELY OVERTURNED THE ACA, BUT OF COURSE PRESIDENT OBAMA VETOED IT. IF THEY USE THAT SAME BLUEPRINT IN THE NEXT YEAR, IT PROBABLY WOULD NOT BE VETOED BY THE PRESIDENT.
TED SIMONS: TRUMP SAID DURING THE CAMPAIGN HE WANTS TO OVERHAUL THE AFFORDABLE CARE ACT BASED ON FREE MARKET PRINCIPLES. WHAT MIGHT THOSE BE?
SWAPNA REDDY: INTERESTING, WE ARE NOT 100% SURE, BUT FREE MARKET PRINCIPLES WOULD SAY THAT PRIVATE COMPANIES LIKE INSURERS COULD COME IN AND BASE PRICES BASED ON HOW MUCH THEY COULD GET FOR PRODUCTS. THAT MIGHT BE DANGEROUS FOR THE 400,000 PEOPLE IN ARIZONA THAT ARE COVERED UNDER MEDICAID EXPANSION, AND THE 22 MILLION PEOPLE IN THE UNITED STATES THAT ARE COVERED UNDER THE ACA.
TED SIMONS: DOES THE ACA, THOUGH, SURVIVE IN ANY WAY, SHAPE, OR FORM, IF THE INDIVIDUAL MANDATE IS GONE, THIS IDEA WHERE YOU'VE GOT TO PARTICIPATE OR ELSE YOU'RE GOING TO GET PENALIZED? I KNOW HE DOESN'T LIKE THAT AT ALL. YOU GET RID OF THAT, IS THERE AN ACA?
SWAPNA REDDY: I THINK IT'S TOUGH TO MAINTAIN THE ACA AS WE THINK OF IT NOW. THE INDIVIDUAL MANDATE IS REALLY IMPORTANT PART OF THE ACA AND REQUIRES EVERYBODY TO HAVE HEALTH INSURANCE COVERAGE. IT'S NOT A PARTICULARLY POPULAR PROVISION OF THE ACA. IF NOT EVERYBODY HAS INSURANCE AND NOT EVERYBODY IS PAYING THE PREMIUMS INVOLVED WITH THE INSURANCE, IT'S HARD FOR THE DOLLARS TO MAKE SENSE. WE CAN'T REALLY CHERRY-PICK WHICH PROVISIONS WE LIKE AND DON'T LIKE. THERE'S A CARROT-AND-STICK SORT OF PRINCIPLE.
TED SIMONS: AGAIN REGARDING THESE FREE MARKET PRINCIPLES, INSURANCE SOLD ACROSS STATE LINES, HE WANTS TO SEE THAT AND HIGHER RISK INSURANCE POOLS. WHAT ARE THOSE?
SWAPNA REDDY: HIS CONCEPT IS TO HAVE HIGH-RISK INSURANCE POOLS FOR PEOPLE WITH PREEXISTING CONDITIONS OR HIGH UTILIZER OF HEALTH CARE AND GIVE MORE POWER BACK TO THE STATE SPECIFICALLY AROUND MEDICATE PROGRAMS.
TED SIMONS: BUT HE HIGH-RISK INSURANCE -- CAN THEY FUNCTION? ARE THEY VIABLE?
SWAPNA REDDY: THERE'S NOT A WHOLE LOT OF DETAIL ABOUT THE HIGH-RISK INSURANCE POOL. HOW EXPERTS LOOK AT THE AFFORDABLE CARE ACT, IT DOESN'T LOOK TOO PROMISING ESPECIALLY WITH THE CURRENT SYSTEM.
TED SIMONS: HE WANTS HEALTH SAVINGS ACCOUNTS. THOSE ARE RELATIVELY SELF-EXPLANATORY BUT THE IDEA OF MEDICAID BLOCK GRANTS, DOES THIS BLOCK GRANT FUNDING SOUNDS LIKE WHATEVER IT IS, IT MEANS LESS MONEY TO ARIZONA.

SWAPNA REDDY: IT WOULD LIKELY RESULT IN LESS MEDICAID DOLLARS TO ARIZONA. BASICALLY, WE HAVE 400,000 PEOPLE LIKE I MENTIONED IN ARIZONA THAT HAVE RECEIVED MEDICAID OR ARE THAT ELIGIBLE FOR MEDICAID THAT WERE NOT PRE AFFORDABLE CARE ACT. THE FEDERAL FUNDING THAT CURRENTLY IS IN PLACE FOR EACH STATE WOULD BE REDUCED, AND EACH STATE WOULD HAVE A BLOCK AMOUNT OF MONEY TO BE ABLE TO HAVE MORE POWER ON HOW THEY RUN THEIR OWN MEDICAID PROGRAMS. IT MAKES SENSE FOR SOME STATES IN PLACES LIKE ARIZONA WHERE WE HAVE A HIGH-NEED POPULATION, WE WOULD BE SEEING LESS MONEY FOR THAT. FAIRLY VULNERABLE POPULATION.
TED SIMONS: SEEING LESS MONEY, FAIRLY VULNERABLE POPULATION. WHAT HAPPENS TO THESE PEOPLE?
SWAPNA REDDY: WELL, WE'RE NOT SURE. WHAT WE DON'T WANT TO HAPPEN IS THEY FALL OFF THE ROLLS AND GO BACK INTO THE KIND OF DEPTHS OF UNINSURANCE. FROM AN ETHICAL AND MORAL STANDPOINT, THAT'S NOT A GREAT PLATE TO BE. FROM A FINANCIAL STANDPOINT, IT'S NOT A GREAT PLACE TO BE. IF THEY'RE NOT HAVING ACCESS TO PREVENTATIVE CARE AND REGULAR INSURANCE, THEY'RE REALLY GOING BACK TO THE EMERGENCY ROOM FOR BASIC CARE. AND THAT ENDS UP BEING MORE EXPENSIVE FOR EVERYBODY ESPECIALLY ALL OF THE TAXPAYERS IN ARIZONA.
TED SIMONS: INDEED. THE 2017 COVERAGE, EVERYTHING IS UNCERTAIN RIGHT NOW. IT'S ALL A BIG FOG OUT THERE. BUT 2017 IS RIGHT AROUND THE CORNER. WILL THINGS CHANGE DRAMATICALLY FOR THE 2017 COVERAGE?
SWAPNA REDDY: THE EXPERTS SAY NO. IT DOESN'T REALLY MAKE SENSE TO SAY THAT A WHOLE LOT OF HAPPEN WITH THE ACA BECAUSE IT CAN'T HAPPEN THAT QUICKLY. ONE THING WE KNOW IS WE'RE IN THE ENROLLMENT PERIOD RIGHT NOW, AND A MILLION PEOPLE IN THE UNITED SIMONS STATES HAVE ENROLLED FOR 2017 FOR ACA COVERAGE THROUGH THE MARKETPLACE. AND ACTUALLY JUST 300,000 ENROLLED THE DAY AFTER THE ELECTION. WHICH INDICATES THERE'S A REAL NEED FOR COVERAGE. IN TERMS OF IF THE RECONCILIATION BILL OR ANY KIND OF REPEAL EFFORTS WOULD BE TAKING PLACE IN CONGRESS, IT LIKELY WOULD NOT FINISH OR TAKE PLACE OR GO THROUGH UNTIL AT LEAST 2018 IF NOT 2019. IT'S NOT THAT SIMPLE.
TED SIMONS: I SAW SOME NUMBERS, THE UNINSURED, I THINK IT WAS IN AMERICA, 16% WHEN THE LAW WAS ENACTED SIMONS. 9% NOW. IF ONE OF THE MAJOR GOALS WAS TO GET PEOPLE INSURED, IT SEEMS TO BE WORKING.
SWAPNA REDDY: ABSOLUTELY. ABSOLUTELY. AND IN ARIZONA, ITSELF, WE WENT FROM 17% TO 10%. SO THERE'S HUGE DROPS NATIONALLY AND THERE'S HUGE DROPS IN ARIZONA. IF THAT WAS ONE OF THE GOALS, WE HAVE BEEN SUCCESSFUL. AND WE CERTAINLY DON'T WANT TO GO BACKWARDS.
TED SIMONS: IS IT POSSIBLE -- THIS IS TOTAL POLITICAL SPEAK. IS IT POSSIBLE HE KEEPS MOST ASPECTS OF THE AFFORDABLE CARE ACT BUT THE REPUBLICANS CALL IT SOMETHING ELSE?
SWAPNA REDDY: THAT'S ENTIRELY POSSIBLE. THAT MIGHT BE WHERE WE FALL. IF WE'RE ALREADY LOOKING AT POPULAR PROVISIONS OF THE ACA AND KEEPING POPULAR PROVISIONS, WE MIGHT BE AT A GOOD NEGOTIATING POINT AT THIS POINT.
TED SIMONS: SO LAST QUESTION. WILL THE AFFORDABLE CARE ACT SURVIVE AS WE KNOW IT?
SWAPNA REDDY: UNLIKELY TO SURVIVE AS WE KNOW IT. AGAIN, THERE ARE CERTAIN PROVISIONS THAT ARE HIGHLY UNPOPULAR, AND THERE'S BEEN A LOT OF CAMPAIGN PROMISES MADE ABOUT REPEALING THE ACA. I THINK WE'LL SEE SOME CHANGES, IN TERMS OF REPLACING THE ACA IS A WHOLE OTHER DISCUSSION. I THINK THE ACA WILL BE A LITTLE DIFFERENT IN TWO YEARS. DOESN'T MEAN IT'LL BE TOTALLY DIFFERENT BECAUSE WE HAVE TO FIND SOLUTIONS THAT WORK FOR THE 22 MILLION PEOPLE THAT WERE UNINSURED AND ALL OF THE FOLKS THAT RELY ON IT FOR HEALTH CARE.
TED SIMONS: IT'S AWFULLY GOOD TO SEE YOU AGAIN. THANKS FOR JOINING US.
SWAPNA REDDY: THANKS FOR HAVING ME.

Swapna Reddy, clinical assistant professor in Arizona State University's School for the Science of Health Care Delivery.

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