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RIP Obamacare Webinar Slides
- 1. Obamacare RIP 25 January 2017 War Room
- 2. HiddenLevers War Room Open Q + A Macro Coaching Archived webinars CE Credit Idea Generation Presentation deck AccountabilityScenario Updates
- 3. Market Update ACA Repeal Trump vs GOP plans Scenario: TrumpCare Obamacare RIP NEW
- 5. Market Update sources: HiddenLevers, Bloomberg, Times UK, Bloomberg 2 Trump Twitter Currency + Politics Empty Executive Branch 1. British Pound 2. Mex Peso 3. Bitcoin 4. Chinese Yuan 5. Indian Rupee
- 7. 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
- 8. 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.
- 9. 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)
- 10. HiddenLevers TRUMP VS GOP PLANS
- 11. 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 states 1. Keep Obamacare if you wish 2. 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
- 12. 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
- 13. 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
- 14. 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
- 15. 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
- 17. SCENARIO: Healthcare Costs + new POTUS sources: MarketWatch, HiddenLevers Healthcare Costs TrumpCare Trump wins ACA targeted
- 18. GOOD: Radical Transformation source: HiddenLevers Bipartisan effort to create basic universal coverage price transparency + competition Singapore model UNLIKELY 60 votes needed
- 19. 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
- 20. 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
- 21. 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.
- 22. 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