Is Mike Pence’s Medicaid Expansion a Blueprint for Donald Trump’s Health Care Reform?

By David Orentlicher

[cross-posted at]

Donald Trump’s pledge to repeal and replace the Affordable Care Act has looked much more like a plan for repeal than a plan to replace, especially in light of the kinds of reform proposals advanced by leading Republicans in Congress, including Trump’s designee for Secretary of HHS, U.S. Rep. Tom Price.

But Trump’s recent promise of “insurance for everybody,” suggests that he might actually have a serious replacement in mind. While we cannot automatically take Trump at his word, it may be the case that he is following the example of his Vice President-elect Mike Pence, who as Governor of Indiana defied Republican positioning in signing on to the Affordable Care Act’s Medicaid expansion.

Pence brought the Medicaid expansion to Indiana by rejecting the traditional federal model for Medicaid and securing permission from HHS for Healthy Indiana Plan 2.0. By including a health savings account feature and other elements of “personal responsibility,” Pence could rely more on conservative principles and claim he was taking a common sense Hoosier approach rather than an Obamacare approach to covering the indigent in Indiana.

So maybe Trump has something similar in mind. A health care plan that really is designed to provide broad access to coverage but that does so via conservative political philosophy. Conservatives prefer to give vouchers to low-income families so they can purchase goods and services in private markets rather than receiving their goods and services from the government. There already is a successful model in the United States for vouchers to purchase private health care coverage—Medicare Advantage. Medicare recipients can choose private health care coverage rather than enrolling in traditional Medicare, and the government pays the premiums for the private coverage. A Medicare Advantage-kind of approach to health care reform would allow Trump to fulfill his promise of insurance for everybody while remaining faithful to conservative principle.


David Orentlicher, MD, JD, is the Judge Jack and Lulu Lehman Professor at UNLV William S. Boyd School of Law, Director of the UNLV Health Law Program, and a Member of the Nevada Assembly.

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