Repub­li­cans have a counter, though no one yet knows what it is.  Pres­i­dent Trump has promised…to show what it is after the 2020 elec­tions.  He has endorsed some pro­pos­als already, which may be includ­ed in his more com­pre­hen­sive plan.  One (Gra­ham-Cas­sidy) shows the elim­i­na­tion of the ACA Med­ic­aid expan­sion and insur­ance sub­si­dies, with the mon­ey being real­lo­cat­ed to the states, who would also be able to over­ride some ACA ben­e­fit stan­dards.  The 2020 White House bud­get points to this by cre­at­ing block grants to the states for a sim­i­lar pur­pose.  Con­ser­v­a­tives also have a plan, which fol­lows a sim­i­lar path.  In short, every­one is against hav­ing the Fed­er­al gov­ern­ment run it – they are all pass­ing to the states.

Of course, Trump real­ly does need a plan, giv­en that his 2020 bud­get calls for a cut of more than $845 bil­lion in Medicare, pur­port­ed­ly to “cut waste, fraud and abuse.”  The OMB direc­tor said “he’s not cut­ting Medicare in this bud­get” so…so how can we have Medicare for all when Medicare itself is always under attack?

The gen­er­al group­ing of pro­pos­als are:

  • Pass­ing block grants and fund­ing to the states
  • Adding pub­lic plan fea­tures to pri­vate insurance
  • Giv­ing peo­ple a choice of pub­lic plans along­side pri­vate plans (e.g. Medicare for those age 50 to 64 while still being able to buy pri­vate insur­ance instead)