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The President-Elect and Republican leaders in Congress have promised to repeal, and at some point, “replace” the Affordable Care Act.  They also plan to gut the Medicaid program by imposing block granting or per-capita caps.  Speaker Ryan, Trump’s nominee for HHS Secretary Rep. Price, and many others in Congress also want to further privatize Medicare by turning it into a voucher program. 

These are not isolated threats to be analyzed and defended against individually.  Rather, these efforts comprise a collective threat to the health care and coverage of millions of Americans.  Drew Altman of the Kaiser Family Foundation recently noted that, if carried through, this “health policy trifecta” would “fundamentally alter the direction of the federal role in health and core elements of the social contract” in a manner that would be “likely to shift costs to individuals and states as well as reduce consumer protections–and result in a significant increase in the number of uninsured.”

Repeal of the Affordable Care Act (ACA) would eliminate health insurance coverage for over 20 million people.  This would include roughly 10 million people who have Medicaid thanks to expanded coverage through the ACA. A full repeal of the ACA would also reduce the solvency of Medicare’s Part A trust fund, re-open the Part D prescription drug “donut hole” and, among other things, remove coverage for a number of preventive services (although some ACA “replacement” proposals quietly keep the Medicare savings in order to offset the costs of killing the ACA).

Gutting the Medicaid program through block-granting or imposing per-capita caps would likely impact tens of millions of low-income families through cuts to eligibility, benefits and provider payments.  This would include the roughly 10 million people who have both Medicare and Medicaid (known as “dual eligibles”) for whom Medicaid can cover Medicare premiums, cost-sharing and additional benefits.

Privatizing Medicare through premium support/vouchers would replace Medicare’s promise of a defined benefit with a coupon to shop for coverage, launching the traditional Medicare program chosen by two-thirds of beneficiaries into a death spiral.

The threats are real.  And they are imminent, with some policymakers suggesting that they should all be dealt with at once. Help protect the social contract and stand up for our health care.

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