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Medicare: Ryan’s plan converts Medicare into a voucher (i.e., defined contribution), and not, as
it is today, a guaranteed level of funding for a defined set of benefits. Trump’s plan cancels the
ACA’s payment reforms, as well as eliminates the tax on higher income Americans that
generates revenues to extend the solvency of the Medicare Part A Trust Fund.
Outline of Proposals
President-Elect Trump, as part of his presidential campaign, proposed to repeal the ACA, most recently
proposing to call a special session of Congress to address the issue. And in June, Speaker Ryan issued a
report outlining his health care reform elements, which included the full repeal of the ACA. With their
wins in the November 8 election, Republicans likely will move forward with efforts to repeal or scale
back the ACA.
The health care proposals offered by President-Elect Trump and Speaker Ryan are outlined below.
Trump Approach
Trump has proposed a seven-point approach that would repeal ACA in its entirety and implement
several policies generally supported by Republicans. As published on the Trump campaign Web site, the
following is the Trump approach:
1. Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate.
No person should be required to buy insurance unless he or she wants to.
2. Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan
purchased complies with state requirements, any vendor ought to be able to offer insurance in any
state. By allowing full competition in this market, insurance costs will go down and consumer
satisfaction will go up.
3. Allow individuals to fully deduct health insurance premium payments from their tax returns under
the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress
allow individuals the same exemptions? As we allow the free market to provide insurance coverage
opportunities to companies and individuals, we must also make sure that no one slips through the
cracks simply because they cannot afford insurance. We must review basic options for Medicaid
and work with states to ensure that those who want healthcare coverage can have it.
4. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free
and should be allowed to accumulate. These accounts would become part of the estate of the
individual and could be passed on to heirs without fear of any death penalty. These plans should be
particularly attractive to young people who are healthy and can afford high-deductible insurance
plans. These funds can be used by any member of a family without penalty. The flexibility and
security provided by HSAs will be of great benefit to all who participate.
5. Require price transparency from all healthcare providers, especially doctors and healthcare
organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for
procedures, exams or any other medical-related procedure.
6. Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is
required in the current Medicaid structure. The state governments know their people best and can
manage the administration of Medicaid far better without federal overhead. States will have the
incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.