The Republican “End Run” on Our Health Plans

One Administration END RUN has been struck down.[1] A federal judge ruled against the Trump administration’s highly touted small-business health insurance plan, calling it an “end run” around consumer protections provided by the Affordable Care Act. At issue in the latest ruling are so-called “association health plans,” in which businesses and sole proprietors can band together to offer lower-cost coverage that doesn’t provide all the benefits required under the Affordable Care Act.

That said, STILL IN PLAY:[2]

  • The Trump administration has reversed its stance on the Affordable Care Act, arguing in a court filing March 25, 2019 that the entire law should be eliminated instead of just removing provisions protecting people with preexisting conditions. Attorney General William Barr doubled down on 9 April 2019 on the Trump administration’s decision not to defend the Affordable Care Act, telling House lawmakers “let the courts do their job.”[3]
  • Short Term health plans still on the table.
  • A NEW HEALTH CARE PLAN will be unveiled after the 2020 elections.

If the Trump Administration gets its wish and the courts end the Affordable Care Act, the number of uninsured people in the U.S. would jump by nearly 20 million. The loss of coverage would lead to considerable increases in uncompensated care. The Urban Institute estimated the amount at $50.2 billion, which would be an 82% increase compared to ACA levels.[4]

Meanwhile, other aspects of our current FOR-PROFIT HEALTH CARE INSURANCE MULTI PAYER model have made their voices known.  In case you have forgotten what our current four party system looks like:

healthcare insurance three-party-system chart



  • 49 percent paid for by the Employer (147 million of us)(Some sources say as high as 56% in 2017)
  • 19-21 percent paid through Medicaid (74.4 million)( one source said 19.3% in 2017)
  • 14 percent paid through Medicare (57 million)(one source said 17.2% in 2017)
  • 9 percent Uninsured (28.5 million)(was 18% in 2013–>10.9% in 2016–>8.8% in 2017–>4thQ 2018-13.7%-15.8%)
  • 7 percent self paid through ACA Marketplace (non group) (17.6 million)
  • 1-2 percent paid through VA/TRICARE (8.1 million)(“military” coverage at 4.8% in 2017 from one source)

Employers (THIRD PARTY), who provide 49 percent of all health insurance coverage (see THIRD PARTY PAYER above) overwhelmingly support the ACA’s pre-existing condition protections. This is one of the provisions being flogged by the present Administration in court.

A new Mercer survey of 600 employers found that 95 percent support Congress preserving coverage for pre-existing conditions as the Affordable Care Act calls for. Nearly half of employers surveyed back expanded subsidies to help people pay for ACA plan coverage.  One-third believe the administration should stop expanding short-term health plans. And 30 percent support more money for ACA exchange outreach efforts.

elephant-donkeyThere is a FOURTH PARTY involved behind the scenes. They may look vaguely like politicians and such but in reality, they are a mixed group.  These are the DECISION MAKERS. They are not necessarily Physicians even though they may be part of the Provider or Payor community. How they “decide” impacts how disenfranchised the Consumer and Provider of Health Care will become. They may even be Congressman and Senators … or Presidents. And their main function is to navigate our model and produce the profit. This is the ADMINISTRATIVE COST of healthcare:

  • Up to 18% in commercial plans [6]
  • 2.2% for Medicare [7]

Next time we look at the Democratic positions.




[1] “Trump administration’s Obamacare alternative struck down by judge,” CBS News 29 Mar 2019,

[2] Muchmore, Shannon, “Trump admin now backs elimination of ACA in court, HealthCareDive, 26 Mar 2019,

[3] Luhby, Tami and Kate Sullivan, “Trump attorney general on ACA lawsuit: ‘Let the courts do their job’,” CNN Politics, 9 Apr 2019,

[4] Bloomberg et al, “State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA,” Urban Institute, March 2019,

[5] approximate numbers based on multiple sources and were usually described as had this type of insurance at one time in the year described.  People drift in and out of coverage throughout the year, ergo the variability of the numbers

[6] Day, Himmelstein, Broder, Woolhandler – Int. J Health Serv 2014 Updated data from firms’ SEC filings (Q12016)

[7] 2016 Medicare Trust Fund Report, 13 Jul 2017,

By | 2019-07-09T10:13:54+00:00 June 25th, 2019|Categories: Healthcare|0 Comments

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