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Trump administration likely to challenge Obamacare, Medicaid expansion, experts say

Donald Trump and other Republicans have repeatedly vowed to repeal President Obama’s health care law since it was passed six years ago.
Donald Trump and other Republicans have repeatedly vowed to repeal President Obama’s health care law since it was passed six years ago.
Composite photo; Paul Sancya and Evan Vucci, Associated Press photos

SALT LAKE CITY — Late Tuesday night, as Republican presidential nominee Donald Trump closed in on a stunning win over Democratic nominee Hillary Clinton, Salt Lake City resident Elicia Lytle opened her computer and posted on a Facebook group for Type 1 diabetics.

“Is anyone else nervous about Donald Trump winning the presidency because of the Obamacare health care regulations?” she asked.

Lytle, 30, has Type 1 diabetes. The small-business owner and mother of two credits the Affordable Care Act with helping her get coverage that makes it possible for her to afford prescriptions that run at least $1,000 a month despite her pre-existing condition.

“There are changes that need to be made (to the law),” Lytle said, the day after the election. “But there’s good things with that that I’m just hoping he doesn’t get rid of.”

Trump and other Republicans have repeatedly vowed to repeal President Barack Obama’s health care law since it was passed six years ago.

Experts say that a Trump administration, backed by a GOP-controlled Congress, has a good chance of doing that.

Jason Stevenson of the Utah Health Policy Project assured consumers that those who purchase plans this year will see them honored for the coming year.

"Because these insurance contracts are already out there, they can't nullify them very easily," Stevenson said.

But Stevenson also acknowledged that significant changes are likely in store for the Affordable Care Act, even if it’s not entirely clear what Republicans will replace it with.

In June, Trump put forth a short health care proposal that includes repealing Obamacare, eliminating the requirement to have health insurance and allowing the sale of health insurance across state lines.

House Speaker Paul Ryan has proposed a plan of his own that also removes the individual mandate but keeps popular Obamacare tenets such as allowing dependents to stay on their parents’ plans until age 26 and not allowing insurers to deny people coverage for pre-existing conditions.

However, Stevenson said he is concerned that Ryan's plan creates a strict one-time open enrollment period that doesn’t guarantee that those with pre-existing conditions won't be discriminated against if they lose their insurance halfway through the year.

Stevenson called these "trap doors."

"They can't be denied coverage, " he said. "But they can be priced out."

Stevenson also raised concerns about Ryan's plan to bring back high-risk pools for the very sick.

A high-risk pool “has never been sustainable,” he said, and is “bringing us back to the pre-Affordable Care Act world where the sick people are in one insurance that’s increasingly expensive, and the healthy people have options of insurance that are cheaper because the sick people aren’t there.”

The shaky future of the Affordable Care Act also throws into question one of the most contentious issues in the Utah Legislature: Medicaid expansion.

House Majority Leader Rep. Jim Dunnigan, R-Taylorsville, said it was too early to know how the political shakeup will affect Medicaid expansion in Utah.

The Legislature approved a small-scale expansion in the last legislative session that is currently under review by the federal government.

Dunnigan said the new secretary of health and human services, appointed by Trump, will have “a lot of latitude” when it comes to the Affordable Care Act.

“How they use that, I don’t know,” Dunnigan said. “I don’t even know if (Trump) knows.”

A spokesman for the Centers for Medicare and Medicaid Services in Denver said the office would not discuss the status of Medicaid expansion waivers until they reached a final decision.

Stevenson said he believes the issue of Medicaid expansion in Utah is "probably off the table.”

“I don’t think we’re going to have that discussion here in Utah again,” he said.

When it comes to drug pricing, a major driver of health care costs, experts said they're more hopeful.

Erin Fox, director of drug information at University of Utah Health Care, said specifics are few and far between.

However, Fox said she is encouraged by several bipartisan bills focusing on getting drugs — particularly generics — approved more quickly, including one sponsored by Sen. Mike Lee, R-Utah.

“Especially for the GOP platform of business and pro-competition, this seems to fall right in line with that," she said. "Something like this could go a long way toward getting more generics approved, adding that competition and then hopefully lowering drug prices.”

However, Fox criticized some of the ideas Trump has proposed, including one allowing Americans to import cheaper drugs from abroad.

Countries like Canada, which has a smaller population than California, are dealing with drug shortages themselves, she said.

“A GlaxoSmithKline product in the U.S. can cost four times, five times, 10 times more in Canada, so GlaxoSmithKline would not have any incentive at all to increase production, because they don’t want their product to be purchased in the U.S. at a lower price,” Fox said. “We’re footing the bill on that because we don’t have a single-payer driver.”

Repealing the law may also be challenging due to the approximately 20 million people who received insurance for the first time under the law, she said.

Repealing Obamacare is "going to be stickier, I think, than just saying it," Fox added.