Daliah Wachs, MD, FAAFP
The calls for repealing Obamacare have been loud and clear. Premiums and deductibles have skyrocketed, provider shortages surged, full time employment opportunities have dropped and the list goes on. Subsidies are a temporary bandage and not enough “healthy patients” are putting money into the system by purchasing plans.
The expansion of Medicaid did allow millions to of Americans to become insured, but it did not necessarily give them healthcare. Access is still limited with provider shortages and a study out of Oregon cited many recipients were still compelled to use emergency rooms for their primary care.
So Obamacare’s demise has been inevitable, and no matter who had won this election, either candidate was going to mend our current healthcare system with a spin of their own. Now we anxiously await the plan on how we replace Obamacare. The repeal can’t come with the same velocity as the ACA was created and passed. Cannonballs are too disruptive to a very fragile system. My suggestions, therefore, to President Trump in his first year in office is the following:
- Cancel the penalty for tax year 2016. This penalty will rise to 2.5% of one’s total household adjusted gross income which maxes at $2085 ($695 per adult and $347.50 per child) for those who did not purchase health insurance. This tax money will be offset by the lack of expenditures for IRS agents hired to enforce this.
- Convert the employer penalties to incentives. Rather than penalizing employers for not providing health insurance, offer tax breaks/incentives for every employee for which insurance is provided.
- Offer a tax break to the employer for every full time employee he hires. We need to plan ahead as automation is taking over many jobs and we want employers to find it financially beneficial to KEEP the employee.
- Offer a low cost Medicare-type plan that Americans can purchase that offers basic coverage
- Maintain the current Medicaid expansion if states can continue to keep funding them.
- Allow competition between states when it comes to insurance plans
And this is just the beginning. A step by step approach that incentivizes the hiring of full- time employees, ends the penalties, opens up interstate markets and doesn’t disrupt current coverage is the simplest, and most methodical way of overhauling our current health care system.
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network and Board Certified Family Physician