'No more Obamacare'? House Speaker predicts what a Trump return would mean
The legislative agenda could rely heavily on proposals developed by physicians serving in the House.
House Speaker Mike Johnson predicted earlier this week that the return of Donald Trump to the White House would lead to major changes in the current Affordable Care Act federal health policy framework, including an end to Obamacare, according to a campaign event video posted by NBC News.
BenefitsPRO could not independently confirm the validity of the video.
NBC News says the video came from an appearance Johnson made in Bethlehem, Pennsylvania, Monday while campaigning for Rep. Ryan Mackenzie, R-Pa.
While the Louisiana Republican was talking about Republicans’ health policy plans and plans for all forms of federal regulations, an audience member asked, “No Obamacare?”
“No more Obamacare,” Johnson said, smiling. “The ACA is so deeply ingrained. We need massive reform to make this work, and we’ve got a lot of ideas about how to do that.”
The Affordable Care Act is made up of two laws that were passed in 2010.
The package includes a wide range of provisions affecting everything from out-of-pocket costs for people with Medicare Part D coverage to support for medical education programs. The commercial health insurance provisions created the current federal major medical insurance underwriting rules, the premium tax credit subsidy system and the Affordable Care Act public exchange system, including HealthCare.gov.
Johnson did not give details during the campaign event about whether he opposes specific parts of the ACA package or all of it.
But Johnson said that he believes that Republicans need to “take a blowtorch to the federal regulatory state,” to keep federal regulators from interfering in the health care market and other markets.
During the first 100 days in the next Congress, “health reform’s going to be a big part of the agenda,” and much of the effort would be based on a collection of proposals developed by Republican physicians who serve in the House, Johnson said.
“If you take bureaucrats out of the health care equation, and you have the doctor-patient relationship, it’s better for everybody,” Johnson said. “More efficient, more effective. That’s the free market. Trump’s going to be for the free market.”
The Trump campaign itself has avoided taking a clear position on ACA change proposals.
Trump himself has indicated that he believes that the ACA framework has created bad, expensive health coverage, but that he wants to have a better framework in place before eliminating the ACA framework.
Related: Trump-Harris debate: Takeaways on ACA, private health insurance
The history: Before 2010, health insurers in most states could reject applicants with conditions such as cancer, diabetes or obesity. Some health insurers used inaccurate answers on coverage applications as grounds for refusing to pay claims for patients who already had coverage in force.
Democrats in Congress developed many of the current ACA provisions that affect commercial health insurance, such as minimum benefits standards and pricing rules, in an effort to eliminate most use of medical underwriting in medical insurance sales.
Surveys have shown that fewer than 30% of Americans support the idea of letting insurers tie the cost of insurance to people’s health.
The future: Trump’s vice presidential running mate, JD Vance, has implied that a replacement could involve “risk pools,” or special arrangements for people with preexisting health conditions, to help reduce the cost of coverage for healthy people.
Vance appeared to imply at one point that the risk pools might serve people with preexisting conditions directly, but he later indicated that he was talking about special reinsurance programs that might operate behind the scenes, without affecting consumers’ list of coverage choices.
Traditionally, Republican opponents of the ACA framework have also supported programs, such as association health plan programs, that could help insurance buyers in states with expensive health benefits mandates shop for coverage in states with fewer mandates.
The heart of many Republican health system change proposals has been the introduction of new types of health savings account programs that could help people use their own cash to buy health care services directly from providers, without intervention from health insurers or government programs.
The proposals could help employers’ efforts to fight benefit plans red tape, but they might have negative or mixed effects on benefit plan efforts to use health care provider networks to manage costs.