Trump’s ‘concept’ of a healthcare plan could hurt Nevadans. Here’s why. 

After Trump offered little detail about how he would repeal and replace the Affordable Care Act, ‘concepts of a plan are just not going to cut it at this point in the game,’ one Las Vegas nurse said. 

As the leader of the Republican Party for the last eight years, former President Donald Trump has spent nearly all of that time trying to rally fellow conservatives to replace and repeal the Affordable Care Act (ACA). 

Starting in 2016, before becoming his party’s eventual nominee, Trump posted to social media that he would “immediately repeal and replace,” the law, also known as the ACA or Obamacare. He doubled down on that promise throughout the campaign trail and throughout the early years of his presidency, and despite more than 70 attempts to repeal the ACA, Republican-led plans were never able to successfully clear Congress. 

At Tuesday’s presidential debate in Philadelphia, with a chance to explain to the estimated 67 million viewers watching on television, Trump said he still supported replacing and repealing the ACA. But when asked how he would accomplish that, he offered few details. 

“I have concepts of a plan,” Trump said. “I’m not president right now. But if we come up with something, I would only change it if we come up with something better and less expensive. And there are concepts and options we have to do that. And you’ll be hearing about it in the not-too-distant future.” 

First enacted in 2010 by former Democratic President Barack Obama, Trump’s predecessor, the law sought to provide the some 50 million Americans living without health insurance access to affordable plans. As of January, more than 21 million Americans have signed up for ACA marketplace coverage, according to the US Department of Health and Human Services — a 31% increase over the previous year and the highest enrollment total to date. Roughly 24 million people also have insurance coverage thanks to the ACA’s Medicaid expansion. 

Another provision of the ACA requires private insurers to accept patients who have “pre-existing conditions,” defined as health issues like asthma, diabetes, cancer or other ailments diagnosed before the start of a coverage plan — which represents between 50 million and 129 million Americans under the age of 65, according estimates by the Centers for Medicare & Medicaid Services. That’s in addition to 80 million people nationwide on Medicaid, a public health plan for low-income recipients. 

Dr. Joseph Adashek, a board-certified OB/GYN who specializes in high-risk pregnancies, said one of the most important stipulations of the ACA is the requirement that keeps young adults under 26 on their parents’ health plan. Coupled with the recent Medicaid expansion initiated by President Joe Biden’s administration, fewer people are being treated without insurance.

“I think that’s something that helped significantly,” said Adashek, the incoming president of the Nevada State Medical Association, the state’s largest physician advocacy group. “Being able to cover pre-existing conditions and insurance companies couldn’t drop you, that was something that helped our patients. With expanding Medicaid coverage, we have less patients who have zero insurance than we used to.”

A repeal of the ACA, especially without an immediate replacement in place, could have a drastic impact on health outcomes for millions across the country, including several in Nevada. Though Adashek said he thinks the ACA has been around for so long now, removing it in its entirety wouldn’t seem feasible. 

“It’s like saying someone’s going to come in one day and get rid of all of Medicare and Medicaid,” he continued. “Well, it’s not feasible. It’s not going to happen.”

Elizabeth Bolhouse, a registered nurse who works at a Las Vegas public hospital, told The Nevadan the ACA has become a service that many of her patients rely on, and a change to the status quo could literally be the difference between life and death. 

“It’s been significant, to be able to help get patients and funnel them through a way to get health insurance, it allows them to get prescriptions, which maintains and improves their health so that they stay out of the hospital,” said Bolhouse, who is also a steward for SEIU Local 1107, a union that represents nurses and other healthcare employees. 

Bolhouse added she was already likely voting for Trump’s opponent, Democratic Vice President Kamala Harris, but was shocked to hear about Trump’s lack of a plan. 

“The whole thing about running for political office is that you have a plan, and you’re selling the public your plan so they know who to vote for,” Bolhouse said. “And something like the ACA was so complex to coordinate and draft, there are so many legal challenges, that ‘concepts of a plan’ are just not going to cut it at this point in the game.”

Last year, the White House provided state-by-state breakdowns estimating how damaging an ACA repeal would be. In Nevada, the Biden-Harris administration said roughly 31,000 Nevadans would see higher insurance premiums by an average of $5,300 annually, but noted that price hikes would disproportionately affect those living in rural areas. 

At least 487,000 people in Nevada with pre-existing conditions would lose protections. That’s on top of an additional 432,000 who would lose access to their ACA plan or expanded Medicaid coverage, while thousands more would be at-risk of losing access to preventative services like cancer screenings, cholesterol tests and annual check-ups. 

Harris, meanwhile, pledged her potential administration would not only preserve the ACA, but work to expand popular provisions set in place by President Joe Biden to all Americans. The Inflation Reduction Act allowed for Medicare to directly negotiate drug prices for 10 widely-prescribed medications, as well as capped out-of-pocket prescription costs for seniors at $2,000 annually and a $35 ceiling on  insulin costs per month for those on Medicare.

“Access to health care should be a right and not just a privilege of those who can afford it,” Harris said. “The plan has to be to strengthen the Affordable Care Act, not get rid of it.” 

To voters like Bolhouse, that sounds like a much better plan than the alternative. And in a swing state like Nevada, those motivated by Harris’ health care plan could mean all the difference for who wins November’s election. 

“I thought she did an excellent job,” Bolhouse said of Harris’ debate performance. “As healthcare professionals, our duty is to do no harm and take care of people. I felt like former President Trump, he never connected the dots, and I don’t think he sees how it affects the average citizen.”

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