We are waking up to a profoundly different world today.
Defying almost all expectations, Republican Donald Trump was elected president in the closest election since 2004. His party also held onto the U.S. House and Senate.
The aftershocks of Trump’s victorious outsider bid will be felt deeply around the world, and the health policy realm is no exception.
Trump campaigned on a platform of repealing the Affordable Care Act. The Republican-controlled House and Senate have already passed a bill to repeal it, which was vetoed by President Barack Obama. As of this morning, the ACA’s days appear to be short.
What will that mean? First, if Trump follows through on his pledge to repeal the act entirely, it would mean no more federal funding for expansion of Medicaid eligibility. In Colorado, nearly 400,000 Medicaid members could lose their coverage.
Second, tax credits for individual market insurance customers would be repealed. Connect for Health Colorado, the state’s insurance marketplace, could continue because it was created by an act of the state legislature, not Congress. But its customers would lose access to their tax credits.
The individual mandate to carry health insurance also would be repealed. And the prohibition against denying insurance to people with pre-existing health conditions would also be thrown out. (Speaker of the House Paul Ryan has voiced support for keeping the ban on discrimination against people with pre-existing conditions; however, insurers will oppose this idea without an individual mandate to make sure that people don’t wait to buy insurance until they get sick.)
Taken together, these changes would be all but certain to raise the uninsured rate from the historic lows achieved under the ACA.
Trump has been vague about his plans for an ACA replacement, but he has mentioned promotion of health savings accounts and allowing insurance companies to sell policies across state lines.
Colorado also counts on federal matching funds from the Hospital Provider Fee to pay for both Medicaid expansion and state payments to hospitals. Several states have funding mechanisms similar to the Hospital Provider Fee, but Republicans have been critical of the setup. Will the Trump administration be as friendly to the idea as President Obama was? For Colorado’s, it’s a billion-dollar question.
Suffice to say, we will be looking at a dramatically different policymaking environment in Washington on January 20. We will need to carefully follow the effects the health care business and its employers, as well as consumers.
From our narrow vantage point inside Colorado, the election changed very little. The state’s results cut against the national grain. Television networks called the state for Clinton less than two hours after the polls closed, and Democratic Senator Michael Bennet was reelected by a four-point margin. There were no changes in the U.S. House.
Republicans held the state Senate with an 18-17 advantage. Democrats picked up a seat in Jefferson County when Rachel Zenzinger beat incumbent Laura Woods, but they lost an open seat in Adams County when Republican Kevin Priola beat Jenise May.
Democrats made gains in the House, ousting Rep. Kit Roupe in Colorado Springs, Joann Windholz in Denver’s northern suburbs, and possibly J. Paul Brown in southwestern Colorado. Although votes are still being counted, it appears Democrats will end up with a 37-28 majority in the state House.
Voters rejected ColoradoCare, the taxpayer-financed universal health system, by a four-to-one margin.
They approved Proposition 106, to allow physician aid in dying, by a two-to-one margin. They also approved a raise in the minimum wage but rejected a hike in the tobacco tax.
At first glance, these Colorado results seem all over the place to me. But maybe there’s a pattern. Voters went for the status quo in their leadership at the state and national levels. In the ballot issues, they opted for individual rights and freedom. They supported better pay for workers and the right to end one’s life. They rejected ColoradoCare’s massive overhaul of the health system and a new tax on tobacco, although a tobacco company’s $16 million in spending against the initiative likely tipped the scales.
Our local results here in the Centennial State support the status quo. The national results upend the status quo. It’s a stunning scenario, and it will take some time to get used to it, whether you’re on the winning or the losing side.
So what’s next? Permit me an editorial comment for the many CHI readers who are dismayed by the election. It’s possible that policies you labored for are now threatened. But sick people will be here tomorrow. Good people whose health troubles put them at a disadvantage will be here tomorrow. Policies will change. But the work of caring for our fellow Coloradans will always be here.
Now more than ever, your efforts are needed.
We got to work right away this morning to make sure our annual conference, Hot Issues in Health Care, addresses the unexpected election results and what they mean for us in Colorado.
You won’t want to miss this year’s gathering, which is in Colorado Springs on December 14 and 15. We will share the latest thinking from our experts and some of Colorado’s sharpest policy minds on the major changes that are coming our way.
Click here to register so you can attend, learn, contribute and strengthen Colorado’s health policy community.