Dr Patricia Salber Talks 2016 Election and the Future of Medicaid

The upcoming election is going to play a large role in the future of Obamacare, which Patricia Salber, MD, MBA, of The Doctor Weighs In, believes will show an increased number of states expanding Medicaid. She added that the ticket will be important in determining the types of legislatures at the state level in the coming years, which in the end determines whether Medicaid will expand in the holdout states.

Transcript (slightly modified)

Is the Affordable Care Act too embedded to be unraveled at this point? Or can something still be done to repeal or replace parts of it?

We have a wild card this year and that wild card is called Donald Trump. Donald Trump has said formally in his platform and his website his number 1 proposal is to repeal Obamacare, in particular the mandate, the individual mandate. But we know that there’s been sort of a difference between what Donald Trump says formally and what he may actually do and then there’s the politics of what he can do. So a lot of it will depend on whether let’s say Donald Trump wins but he comes in with a democratic congress, or at least a democratic senate, how much he can actually get done in terms of unraveling will be really interesting.

And then, there will be huge disruptions in terms of unraveling it economically. Mike Chernew said this would contribute to the deficit, but there would also be the impact on huge numbers of people who for the first time had a taste of health insurance that you would basically be ripping that away from.

What do you think it would take to get the holdout states to expand Medicaid?

This is the United States of America. We never do everything—all 50 states never do everything the same. I mean, that’s the beauty of letting states decide but the downside of letting states decide is that a lot of them, 19 I think, now it’s 18 because 1 just came on board and expanded Medicaid. So 18 states have said we’re not going to do it but if you look at those 18 states, some of the governors, even Republican governors, have said they want to do the Medicaid expansion but they haven’t been able to get it through their legislatures.

So again, what happens in this election this fall, the down ticket, what the shape of these individual state legislatures look like, will determine whether there will be expansion. So I think you’re going to see more expansion because it makes economic sense at the states. It may not make political sense, but it makes economic sense at the states. But I don’t think you’ll see every state coming on board with Medicaid expansion. I hope I’m wrong about that.