RIP Obamacare Webinar Slides
22
Obamacare RIP 25 January 2017 War Room
-
Upload
hiddenlevers -
Category
Data & Analytics
-
view
250 -
download
0
Transcript of RIP Obamacare Webinar Slides
Obamacare RIP25 January 2017
War Room
HiddenLevers War Room
Open Q + A
Macro Coaching
Archived webinars
CE Credit
Idea Generation
Presentation deck
AccountabilityScenario Updates
Market Update
ACA Repeal
Trump vs GOP plans
Scenario: TrumpCare
Obamacare RIP
NEW
HiddenLevers
MARKET UPDATE
Market Update
sources: HiddenLevers, Bloomberg, Times UK, Bloomberg 2
Trump Twitter Currency + Politics
Empty Executive Branch
1. British Pound2. Mex Peso3. Bitcoin4. Chinese Yuan5. Indian Rupee
HiddenLevers
ACA REPEAL
ACA Repeal: Healthcare Status Check
Sources: HiddenLevers, Kaiser Family Foundation, KFF 2
-20M newly insured under ACA, mostly from Medicaid.-ACA, while problematic, is not collapsing as is.-Skyrocketing Healthcare costs pre-date Obamacare
Cease ACA subsidies, using lower court ruling that they aren’t authorized.
Give hardship waivers freely or stop enforcing the individual mandate.
Healthy buyers leave, forcing insurers to raise premiums.
Potential collapse of the insurance market.
ACA Repeal: Trump’s Executive Order
sources: HiddenLevers, NY Times, Washington Post
POTENTIAL ACTION IMPACT
Delay enforcement of business mandates and taxes.
Fewer insured workers.Lower cost of doing business.
ACA Repeal: What lives?
sources: HiddenLevers, CBPP
• Guaranteed Issue• Stay on parents plan til 26• Medicare changes/cuts• Cuts to indigent care
reimbursements
• Exchange subsidies• Medicaid expansion• Capital Gains 3.8% tax• Medical device tax• “Cadillac” policy tax?
Difficult to Remove Repeal Likely
GOP has votes to change budget-related parts of ACA, but can’t increase budget deficit with any changes (Byrd Rule)
HiddenLevers
TRUMP VS GOP PLANS
Trump vs GOP: Key Differences
sources: HiddenLevers, Politico, Business Insider, Business Insider 2
Trump, POTUS-insurance for everybody-drug price negotiation
Tom Price, HHS-No concern for coverage gains-Kill the individual mandate-Blind Tax credits for insurance-No one can be denied coverage-HSA expansion
GOP Senate (Cassidy + Collins)Push choice to states1. Keep Obamacare if you wish2. Market-based alternative (fed funding)3. Go your own way (no fed funding)
Rand Paul, Libertarian Senator-Kill individual mandate-Kill coverage minimums-5k HSA for every American-No repeal without replacement-Small business insurance pools-2y window for pre-existing conditions
GOP House (Paul Ryan)-Start with Tom Price old bill -Fixed 12k credit for Medicare-No care for universal coverage
Trump vs GOP: Obamacare Winners + Losers
sources: HiddenLevers, Axios
older people – limit on premiums
low income insurers
sick people – pre-existing conditions okay healthy people – forced to subsidize sick
young adults – forced to subsidize elders
blue chip insurers – economics don’t work
low income people – expanded Medicaid middle income people – no subsidy + $$$
healthcare providers – patients now insured drug companies + medical device makers
WINNERS LOSERS
Trump vs GOP: TrumpCare Winners + Losers
sources: HiddenLevers, Center for Budget + Policy Priorities, CNBC, Axios
young people – no longer subsidizing
insurers – protections on dropped coverage
healthy people – no longer subsidizing sick people – higher premiums
old people – no premium limits (5x young)
healthcare providers – losing customers
middle income people – more choices, less $
low income people – Medicaid reigned in
WINNERS LOSERS
state governors – more control over systems
Trump vs GOP: Myth Busting
sources: HiddenLevers, Politico, Washington Post
Trump sees eye-to-eye with his HHS Secretary
GOP has enough votes to repeal ACA
Universal coverage is impossible under Trump
GOP will have replacement before repeal
Trump vs GOP: Singapore = Promising Model
High-deductible health insurance meant to cover major medical expenses
Similar to an HSA, but some contribution is mandatory. Coupled with price transparency
Backstop funding for the poor, if they cannot pay medical bills
sources: HiddenLevers, Ministry of Health, Fox News, FreedomWorks
The most transformative GOP plans include ideas to replace ACA with universal catastrophic insurance + HSAs, like Singapore
HiddenLevers
SCENARIO: TRUMPCARE
SCENARIO: Healthcare Costs + new POTUS
sources: MarketWatch, HiddenLevers
Healthcare Costs TrumpCare
Trump wins
ACA targeted
GOOD: Radical Transformation
source: HiddenLevers
Bipartisan effort to create basic universal coverage
price transparency +
competition
Singapore model
UNLIKELY60 votes needed
NEUTRAL: Stopgap replacement
source: HiddenLevers
GOP carves up Obamacare + fills gaps decently individual mandate
penalty GONE
can be done without
bipartisanship
no hard deadline
GOP internal gridlock
UGLY: Repeal + Run
source: HiddenLevers
GOP cuts Obamacare net with nothing underneath
Medicaid funding cuts = hospital
closures
collapse of private insurance markets
contracting healthcare drags down economy
SCENARIO: TrumpCare
Good:Radical
Transformation
Bad:Stopgap
Replacement
Ugly:Repeal + Run
healthcare inflation
6%S&P 500
-12%
healthcare inflation
3.5%S&P 500
FLAT
healthcare inflation
2.7%S&P 500
+11%
Using catastrophic coverage + HSAs for all, GOP could transform US healthcare, lowering costs and enabling other sectors to grow faster.
Limited ACA replacement measures won’t solve long term cost or coverage issues, but also won’t wreck the market or economy at large.
The healthcare sector would suffer a major decline in revenue, with corresponding job losses, and spillover impact to the economy.
Obamcare RIP – Take Aways
No more 3.8%
Obamacare surcharge
on cap gains
Trump can kill individual mandate + subsidies by
exec order
Repeal + no replacement will hurt health sector + markets
Too early to call Obamacare dead
