What Trump voters with Obamacare want in health coverage

By Danielle Ray
Kentucky Health News

Affordability appears to be one of the most important concerns for Donald Trump voters as the president and Congress go about repealing and replacing the Patient Protection and Affordable Care Act.

In particular, cost of premiums and out-of-pocket expenses were top priorities among Trump voters who discussed the potential Republican repeal and replacement of the ACA at focus groups hosted by the Kaiser Family Foundation in Michigan, Ohio and Pennsylvania in December. All focus group participants were Trump voters who obtained coverage through federally subsidized insurance policies or through Medicaid expansion.

President Trump signing an executive
order to rollback regulations on Obamacare

Participants who had subsidized coverage also wanted broader access to doctors and hospitals, simplified health-plan choices, greater cost-and-coverage transparency, and elimination of the individual mandate for coverage. Those participants also said that coverage of pre-existing conditions (which Trump has said he supports) and the ability to tailor coverage to fit their needs, even if that meant sicker people would pay more for coverage, were also important to them.

While some focus-group participants reported positive experiences with the exchanges that sell subsidized coverage, most were overwhelmed by unaffordable out-of-pocket costs associated with high deductibles. Participants also reported frustration with surprise medical bills and the high cost of prescription medicines.

Data from the focus groups showed that the Medicaid participants faced more serious health issues and greater financial challenges than those in the exchange focus groups. Though most participants did not associate their Medicaid coverage with the ACA, they were satisfied with their plan and were concerned about a possible repeal of the Medicaid expansion.

Participants in the Medicaid groups had mixed views of more minor changes, such as charging nominal premiums to enrollees or incentives for healthy behaviors, as Kentucky has proposed. However, they were not supportive of lock-out periods for failure to pay potential premiums on time, another part of Kentucky’s waiver request to the Trump administration.

U.S. Sen. Lamar Alexander

U.S. Sen. Lamar Alexander (R-Tenn.), also a former governor of the state, recently told Politico that Republicans in Congress will not only keep the Medicaid expansion, but will broaden it.

Alexander said Congress first needs to fix the subsidized insurance markets, “which are suffering from high premiums and low competition, even if they represent just 4 percent of those insured in the United States,” Politico reported. “From there, he wants Republicans to turn to Medicaid expansion — which Republicans will keep and potentially even broaden, he says — before eventually addressing problems with the country’s patchwork of employer-sponsored health care plans. In essence, Alexander is trying to triangulate an approach that can become law.” Compare to-date ACA replacement proposals here.

If Congress does expand Medicaid, it’s likely to be modeled after Indiana’s waiver program, enacted by Vice President Mike Pence when he was governor. The Indiana program is also the model for Kentucky’s waiver request.

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