The American Health Care Act (AHCA) or Trumpcare is associated with the current US administration. The plan sought to repeal the Affordable Care Act or Obamacare that had been associated with President Obama's regime. On May 4, 2017, the AHCA act was passed in the House of Congress. The Republican Party faulted the Affordable Care Act (ACA) citing that it fuelled federal entitlement and the perceived "pitfall of mandating that all Americans have health insurance" (Collier, 2017, 645). It was also deemed to have brought down the quality of healthcare across the United States while at the same time inflating the cost of healthcare for many small businesses and private citizens. Studies point faces equal opposition and affirmation from the public. Trumpcare is a health insurance plan that will replace the Affordable Care Act, and it seeks to deliver enhanced healthcare services based on President Trump’s government. A section of the public believes that Trumpcare is an improvement of healthcare management in the country while others deem it as a ploy to deny vulnerable members of the society a right to health. However, as a federal mandate, the Trumpcare is expected to have severe ramifications for states with Hawaii being one of them.
Hawaii joined the United States as its 50th state on August 21, 1959. Situated in the Central Pacific, Hawaii is home to 1.4 million citizens. The state has been subject to federal mandates that have been tailored to benefit its public. The healthcare reforms have been at the core of the state's operations with various health agencies liaising with both federal and state governments to avail the much-needed coverage and efficiency in the healthcare delivery. As such, the state is hailed for being among the ten states that implemented the Obamacare fully. Hawaii oversaw the setting up of its insurance marketplaces, implemented law insurance reforms, and enhanced the Medicaid coverage (Scott, 2018). Hawaii's leadership has been at the forefront of embracing the Affordable Care Act. However, with the introduction of the Trumpcare, there are bound to be cuts in the federal funds extended to the states to enhance healthcare coverage. It is prudent to note that the ACA oversaw sufficient subsidies availed to the State governments.
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The American Health Care Act (AHCA) projects notable changes that are going to affect the vast majority of the Hawaii residents. It is evident that many people are either too sick or too poor to afford access to proper medical care. Additionally, in many countries and societies there exist a broad consensus that there is need to subsidize care targeting the vulnerable. Unlike the previous program, the AHCA does not institute any federal tax policy for not having health insurance (Scott, 2018). The federal tax policy may be hailed in various circles, but the essence of the penalty is to increase compliance particularly among employers and private citizens. With every citizen under the program, coverage can be expanded, and resources pooled to ensure that more Americans enjoy cheap and quality healthcare. The elimination of the penalties may be a relief to many American citizens that would not want to join the scheme.
Trumpcare affords the states the opportunity to set their policies when it comes to insuring pre-existing conditions through a waiver application. This provision may be embraced by the Hawaii state leadership. However, it is subject to scrutiny due to the vested interests that may exist when it comes to the health agencies and insurance entities in the state. The latter, for instance, may advocate for the denial of coverage of some pre-existing conditions such as cancer. The pre-existing conditions usually present additional medical costs that insurance companies may be forced to meet (Scott, 2018). The Hawaii state government, on the other hand, may focus on striking a balance between public interests and the insurance entities. The state due to its past management of the Obamacare may favor a plan that does not allow denial of coverage or more charges based on an individual's pre-existing conditions.
The AHCA presents income limits on tax credits that may not be tenable in the long run. According to the act, they "begin to phase out at $75,000 for an individual and $150,000 for a family" (Prakash, 2018). The payouts in the past have been used in reducing the health insurance cost. However, with high-income limits as proposed under the Trumpcare chances are that many people will not enjoy the payouts. This will reduce compliance (Collier, 2017). The state may incur the expenses associated with these reductions. Many Hawaii residents may be forced to dig deeper to finance the insurance plan. The state may demand that the federal government either reduces the income limits or increases the subsidies extended its way.
Unlike the Obamacare, the AHCA will see to it a maximum subsidy or credit amount that the federal government will foot. The act stipulates that "the credit ranges from $2,000 per year (for a young, single adult) up to $14,000 per year (for a family that includes older children adults)" (Prakash, 2018). From the above set limits, the Hawaii state government may look for a no fixed dollar limit option. The flexibility is essential when it comes to boosting health coverage across the state. The federal government is also non-committal when it comes to this federal mandate. Previously under the ACA, there existed federal and state insurance online marketplaces where interested parties could shop and compare the available insurance plans (Scott, 2018). It does not take into consideration the socio-economic dynamics at play when implementing the AHCA in different states. As such, the Hawaii leadership will oppose the federal mandate as it offers the state and its resident a raw deal notably because it is touching on a sensitive element-health. The leadership’s input will be integral as the AHCA is unclear on some things such as the future of the insurance marketplaces.
Consequently, the AHCA provides an opportunity for an individual to purchase benefits that he or she prefers. This, however, is subject to the special waiver from the federal government. This particular element is favorable for many Hawaii residents; however, it puts the state at a precarious position when it comes to negotiating with the federal government for the special waivers. The state, through the waiver, may remove health benefits. For instance, the AHCA allows states to remove "women's health benefits such as maternity care, by application of a waiver" (Prakash, 2018). The removal of these benefits may not augur well with the public given that there exist key health pillars that are recognized nationally. It also impacts the focus on quality healthcare across various areas negatively. The federal mandate will make insurance premiums costly especially for the old. Insurance companies can "charge more to sick applicants and older consumers (up to 5 times more than younger consumers)” (Scott, 2018). Given that the elderly are the most vulnerable, the premiums may see more of them disenfranchised from the plan. This would be challenged by many states, Hawaii included.
Trumpcare proposes that “federal expansion to be removed by 2020 with the annual caps to be availed to each state" (Prakash, 2018). This means that the federal support will soon be reduced leaving the states to establish ways to support the healthcare plan. Hawaii will have to expand its revenue streams to sustain the AHCA in the future. It is prudent to note that states have different starting points which may affect how well they manage the expansion. However, given that Hawaii is one of the 13 states that are expanding using their tax revenue, the state will not handle the expansion smoothly as the AHCA comes to effect. The situation will occur since the citizens will bear the burden of the AHCA ramifications.
For the federal mandate to be implemented and thrive in Hawaii, it must be endorsed by the governor and legislators. The governor as the head of the executive must deliberate on whether the AHCA is responsive to the health challenges faced by the Hawaii citizens. The legislature, on the other hand, must determine how the AHCA will be implemented and funded. The two parties will offer direction on how the state will liaise with the federal government to derive the best out of the program with the hope of increasing health coverage and delivery of quality health care (Collier, 2017). The state has continually faced hurdles when it comes to implementing and complying with the "exchange requirements of the ACA" (Hollier, 2017). The Hawaii senator notes that many Hawaiians on Medicare are going to bear the brunt of the Trumpcare plan. She asserts "they will end up paying more for prescription drugs, for example. Moreover, they will not get the kind of preventive care they get under ACA" (Hollier, 2017, 1). This means with the entry of AHCA will also be riddled by notable challenges.
In conclusion, the AHCA as a federal mandate will bring severe changes to the management of healthcare in the United States, and in Hawaii in particular. With much of it funded by the federal government, the plan highly mirrors the structure of the Scathe AHCA, therefore, must take into consideration the various stakeholders within the state. With the Hawaii executive and legislature being its portended oversight, various hurdles must be countered. This means that the state must focus on expanding its revenue base by being innovative to ensure that it does not burden the public in its quest to implement this federal mandate. Being a plan that is yet to be wholly realized, the Hawaii state must strategize and seek to customize the plan for it to benefit its residents.
References
Collier, R. (2017). Why Trumpcare failed. Canadian Medical Association Journal , 189 (17), E645-E646. doi:10.1503/cmaj.1095414
Hollier, D. (2017, November 2). Trump’s effect on Hawaii . Retrieved from https://www.hawaiibusiness.com/trumps-effect-on-hawaii/
Prakash, P. (2018, May 8). Obamacare vs Trumpcare: The 9 key differences between the bills . Retrieved from https://fitsmallbusiness.com/obamacare-vs-trumpcare/
Scott, D. (2018, January 12). The Trump administration's plan for Medicaid work requirements, explained. Retrieved from https://www.vox.com/policy-and-politics/2018/1/11/16877916/medicaid-work-requirements-trump-guidance
