William Seligman and Mataroria Lyndon: Making American healthcare great again?

donald_trump2After eighteen months of breakneck campaigning, there are few who would have predicted the results we saw in the United States presidential election last night. Donald J. Trump, described by President Barack Obama as the “single least qualified candidate for the presidency in the history of the United States,” swept to victory winning traditional conservative states and flipping liberal strongholds. What’s more, the Republican Party now has majorities in both houses of Congress—the Senate and the House of Representatives. Last week, we discussed what we thought might happen given any number of presidential and congressional scenarios. Never did we think we’d be writing again today to discuss the implications of a Trump White House, Republican-majority Senate, and Republican-majority House. But here we are and what does this mean for healthcare in America?

  1. Obamacare to go

We don’t know much about Trump’s plans for healthcare but what we do know is that he is committed to complete repeal of Obamacare. He’s even said he will organize a special session of Congress to dismantle Obamacare “immediately.” With a Republican congress united behind complete repeal, Trump will likely get his way. However, the Senate tradition of the filibuster—the process by which a senator is able to delay voting on an issue for as long as he/she can physically talk—means that repeal will not be quite as straightforward or as swift as Trump might envisage. That said, Obamacare is going to be a thing of the past. What happens to the 20 million previously uninsured Americans who got coverage through Obamacare? Anybody’s guess.

  1. Attempts to reduce health insurance premiums

Trump used his stump appearances to lambast Obamacare for its part in raising the cost of insurance premiums for millions of Americans. How will Trump manage to keep the insurance companies and their premiums under control? The basic economic principle of competition and free markets. By allowing the sale of insurance across state lines, Trump hopes that as the number of insurers increases, prices will be driven  down. We have also heard Trump talking about allowing individuals to deduct the cost of insurance premiums from their tax returns. How will he pay for this? Anybody’s guess.

  1. Attempts to limit the availability of birth control

One of the reasons why this election has got people so fired up on both sides is that it’s likely that this president will nominate anywhere between two and four Supreme Court justices during his tenure. Supreme Court justices serve for life and so this president has the opportunity to influence the judiciary branch of the government for a generation. What has Trump said about the Supreme Court justices he will nominate? For starters, he’s committed to appointing justices who are opposed to the Roe v. Wade ruling that allows women the right to abortion. Should Roe v. Wade be overturned, states will likely have the opportunity to determine the legality of abortion. According to a 2007 report, 21 states are highly likely to ban abortions with a further nine likely to follow suit.

So, we’re going to see significant changes to the US healthcare system over the four or eight years of a Trump presidency. Changes far more sweeping than many could have ever predicted. Changes that may affect an entire generation of Americans. The election results are a function of the American people more than the views or values of any individual candidate. America is more divided today than ever before. Maybe Obamacare wasn’t what the American people wanted. But let’s hope President Trump and the Republican leadership find a solution to America’s great healthcare challenges.

william_seligmanWilliam Seligman completed his Foundation Programme training in the Severn region before embarking on the Master of Public Health program in health policy at the Harvard T.H. Chan School of Public Health. He was previously a Legislative Intern in the United States Senate.



m_lyndonMataroria Lyndon is a physician completing a Master of Public Health in health policy at the Harvard T.H. Chan School of Public Health. He was previously a Clinical Lead at Ko Awatea, Counties Manukau District Health Board, and a PhD Candidate in Surgery at the University of Auckland, New Zealand. 

Competing interests: None declared.