What a Trump election might mean for the ACA

In an article published November 9th on the Health Affairs BlogTimothy Jost, Emeritus Professor at the Washington and Lee University School of Law and a member of the Institute of Medicine, cataloged the potential ramifications of what a Trump Presidency might mean for the Affordable Care Act.  A summary of Jost's arguments are included below:

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Obama administration issues most sweeping rules in a decade for Medicaid enrollees

The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors.

For consumers the most visible change may be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years.

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State and federal health reforms helping marginalized patients

According to Kaiser Health News, state and federal incentives and reforms have created new options for nonprofit organizations to support severely marginalized patients such as drug users and sex workers.

Such organizations or "harm reduction centers" are where such patients can get clean needles, syringes, free condoms and HIV prevention information.  They have existed for decades at the fringes of the health care system and supported by piecemeal and bootstrapped budgets of state and federal agencies.

Such organizations are increasingly trying to reposition themselves as a resource for hospitals and insurers because of their  experience coordinating care for high-risk and often marginalized patients.

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States' stances on Medicaid appear to affect access, Commonwealth Fund suggests

According to the Commonwealth Fund's Biennial Health Insurance Survey, differences in cost and access for the four largest states of Texas, California, Florida, and New York stem from a variety of factors, including whether states have expanded eligibility for Medicaid, each  state’s uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.