America’s health care mandate for President Trump

Kaiser Health Tracking Poll: November 2016

By Ashley Kirzinger, Elise Sugarman, and Mollyann Brodie
Kaiser Family Foundation, December 1, 2016

America divided on ACA next steps

What would you like to see President-elect Donald Trump and the next Congress do when it comes to the health care law?

30% - Expand what the law does

26% - Repeal the entire law

19% - Move forward with implementing the law as it is

17% - Scale back what the law does

03% - None of these/Something else

04% - Don’t know/Refused

Americans have favorable attitudes towards some ACA provisions

Percent who say they have a FAVORABLE opinion of each of the following provisions of the law (for now ignore percent in parenthesis):

85% (83%) - Allows young adults to stay on their parents’ insurance plans until age 26

83% (75%) - Eliminates out-of-pocket costs for many preventive services

81% (71%) - Closes the Medicare prescription drug “doughnut hole” so people on Medicare will no longer be required to pay the full cost of their medications

80% (72%) - Creates health insurance exchanges where small businesses and people can shop for insurance and compare prices and benefits

80% (68%) - Provides financial help to low- and moderate-income Americans who don’t get insurance through their jobs to help them purchase coverage

80% (66%) - Gives states the option of expanding their existing Medicaid program to cover more low-income, uninsured adults

69% (60%) - Prohibits insurance companies from denying coverage because of a person’s medical history

69% (62%) - Increases the Medicare payroll tax on earnings for upper-income Americans

60% (49%) - Requires employers with 50 or more employees to pay a fine if they don’t offer health insurance

35% (16%) - Requires nearly all Americans to have health insurance or else pay a fine



By Don McCanne, M.D.

Based on media reports for the past half year or so Americans seemed to be split on whether they want to keep Obamacare or to repeal it and perhaps replace it with an ill-defined Republican plan. As is usual during political campaigns, the rhetoric did not reveal much in the way of the true feelings of Americans about health care reform. This Kaiser poll provides us much better insight.

Based on the rhetoric, 49% want to move forward with implementing the law as it is (19%) or, even more, wanted to expand what the law does (30% - the largest fraction). In contrast, 43% wanted to repeal the entire law (26%) or scale back what the law does (17%).

But the rhetoric can be quite meaningless, so they polled Americans on what health reform policies they would support, devoid of political rhetoric. By wide margins they supported policies that would improve the functioning of our health care financing system. Most of these policies are supported by the Affordable Care Act. The only policy rejected was requiring Americans to pay a fine if they were unfortunate enough to be uninsured. (Notably absent were policies more specific to single payer, though other studies have shown broad support for such policies.)

So Americans are split on Obamacare but they clearly support the policies of the Affordable Care Act. That may seem ironic, but it exemplifies the difference between communicating with political rhetoric and communicating with policy facts.

Now look at the percentages in parentheses. They show only slightly less support than the cross section of Americans, but still support by a wide margin for policies that would improve health care financing, except for fines for not being insured or for small employers not providing insurance.

Nobody wants to be uninsured, and they would surely object to being fined because they weren’t. Even if we were trying to get everyone insured, fines are a terrible way to do it. Far better would be equitable financing through a single payer system.

So what are the numbers in parentheses? Those are the percentage of Trump voters who support those particular policies. Trump voters!

Imagine that. Trump supporters want beneficial health care policies that would make health care accessible and affordable for everyone. So Donald Trump does have a mandate, but it is to adopt beneficial health policies, not to pare them back nor replace them with market models that benefit insurers to the detriment of patients.

His selection of Tom Price for HHS and Seema Verma for CMS sends us in the wrong direction. It is imperative that the message gets through to Mr. Trump that he should withdraw these two nominations and move forward with appointing health care leaders who would work with Congress to bring us the health care system that Americans really want. With a little more objective thought and less rhetoric, the overwhelming majority, including Trump supporters, would want to see enactment of an improved Medicare for all.