You'll have to forgive me my poor metaphor below, but it's the best I can think of at the moment. I've been awake for 29 hours straight now, as I woke up at 5am yesterday for a 15-hour shift as a poll worker in Pontiac, Michigan, and, like many of you I'm sure, I was unable to sleep at all last night. I just got off a devastating phone call with my son who's a freshman in college who doesn't understand why what just happened...happened.
There's going to be a mountain of digital & physical ink spilled and a cacophony of talking heads on the Sunday morning shows yapping about What Went Wrong, yadda yadda yadda. Most of it will be bullshit. Some of it will be accurate.
Since writing about healthcare is my thing, and writing about the ACA specifically is very much in my wheelhouse, I'm going to put my take on this into healthcare risk pool terms. Besides, assuming the GOP also keeps control of the House, the ACA is likely gone (and even if they don't, it's about to be radically gutted via regulatory actions anyway), so I might as well.
Trump expected to select Robert F. Kennedy Jr. to lead HHS
President-elect Donald Trump is expected to nominate former presidential candidate and anti-vaccine activist Robert F. Kennedy Jr. to lead the Department of Health and Human Services, according to a person with direct knowledge of the selection.
The expected pick, which will roil many public health experts, comes after Trump promised to let Kennedy “go wild” with health and food policy in his administration after Kennedy dropped his own presidential bid to endorse the now-president-elect. It’s also a sign of the opening Trump sees after he scored a decisive electoral victory and Republicans won a comfortable majority in the Senate.
Trump could still select someone else for the post. The Trump transition couldn’t immediately be reached for comment.
“He’s going to help make America healthy again. … He wants to do some things, and we’re going to let him get to it,” Trump said in his victory speech. “Go have a good time, Bobby.”
I want to acknowledge the questions about the future of health policy since Tuesday’s election.
We’ve successfully navigated periods of uncertainty like this several times in the past, including eight years ago, and we didn’t do it alone. You, our customers, stakeholders, and partners, make it possible to move forward together.
There are several things that we know.
The Affordable Care Act is still the law of the land.
Senate Bill 11-200, the state law that created Connect for Health Colorado, is still the law of the state. There are several other important state laws that ensure quality, affordable, and comprehensive health coverage for Coloradans.
There are significant savings available to customers who enroll through the Marketplace for Plan Year 2025.
I've spent the past couple of weeks up to my ears in 2025 annual healthcare policy rate filing analysis, so I haven't gotten around to addressing JD Vance's recent appearance on NBC in which he finally explained exactly what Donald Trump's "concept of a plan" for healthcare is:
When Donald Trump stammered at the recent presidential debate that he had “concepts of a plan” for Americans’ health care, he came across like a child who had forgotten his homework. But thanks to his campaign and his running mate JD Vance, we know now the Republican ticket really does have some “concepts.” Those concepts are bringing health care into the election — and presenting a tremendous opportunity to Vice President Kamala Harris.
Last Sunday, Vance raised the eyebrows of anyone familiar with health care policy when he told NBC’s Kristen Welker about Trump’s “deregulatory agenda.”
Project 2025, also known as the Presidential Transition Project, is a collection of conservative and right-wing policy proposals from the Heritage Foundation to reshape the United States federal government and consolidate executive power should the Republican Party candidate win the 2024 presidential election.
It proposes reclassifying tens of thousands of merit-based federal civil service workers as political appointees in order to replace them with those who will be more willing to enact the wishes of the next Republican president.
It asserts that the president has absolute power over the executive branch.
Critics of Project 2025 have characterized it as an authoritarian, Christian nationalist plan to transform the United States into an autocracy.
Since Donald Trump was defeated in the 2020 Presidential election, most people seemed to be under the impression that the Republican Party's decade-long obsession with tearing down President Obama's signature legislative accomplishment, the Patient Protection & Affordable Care Act, was finally over.
The 2024 ACA Open Enrollment Period is going on right now and will continue through January 16th in most states. So far, I've confirmed that over 4.7 million Americans have enrolled in either ACA exchange Qualified Health Plan (QHP) policies nationally or Basic Health Plan (BHP) policies in New York & Minnesota specifically; the odd are that the combined total will be over 18.5 million by the time the dust settles in January.
"The Democrats are the party that says government will make you smarter, taller, richer, and remove the crabgrass on your lawn. The Republicans are the party that says government doesn't work and then they get elected and prove it." --P.J. O'Rourke, Parliment of Whores
As I noted on Friday, Donald Trump's executive order essentially orders the incoming HHS Secretary (presumably Tom Price), along with other relevant agency heads, to do everything in their power to sabotage the ACA regardless of any repeal legislation (whether partial or total) on the part of Congress. Since the ACA grants the HHS Secretary pretty wide authority about how (and whether) to enforce various components of the law, this gives ample room for the Trump administration to make the individual mandate (among other ACA provisions) effectively meaningless.
Trump also issued a memo to all agencies requesting that they begin to "ease the burden of Obamacare as we transition from repeal to replace," Spicer said. He declined to provide specifics on what various agencies might do in response to the president's directive.
HOWEVER, David Anderson (formerly Richard Mayhew) notes that Section 2, which instructs the HHS Secretary to "waive, defer, grant exemptions from or delay" any "fiscal burdens" o sounds an awful lot like telling them to be absurdly lenient regarding granting "hardship exemptions" from the individual mandate:
@annaedney@ZTracer yes individual mandate exemptions will be passed out like pacifiers at a rave
IMPORTANT: I cannot guarantee accurate federal data after 1/20/17.
...HOWEVER, their bosses...the HHS Secretary and, I presume, the head of CMS...will be appointed by Donald J. Trump and confirmed by a 100% Republican-controlled Senate.
Given Trump's long, disturbing history of flat-out misstatements (aka "making sh*t up out of whole cloth"), and the type of sycophants he's likely to put into place, I can't guarantee with 100% certainty that the numbers spouted off by them are going to bear any connection with reality. Maybe they'll be accurate. Maybe they'll be off slightly. Maybe they'll be completely removed from any actual numbers. Who the hell knows?
Earlier today it was reported that Ben Carson was being considered for HHS Secretary. Then the rumor mill turned to Bobby Jindal. At the moment, I'm hearing it could be Rep. Tom Price, who (like pretty much every other GOP member of Congress) despises the ACA. That doesn't guarantee that he'll Make Sh*t Up, of course, but under a Trump regime, anything's possible. Anything.
