As the political world reacts to Donald Trump’s victory, insurance and healthcare policy experts have little idea who will lead the President-elect’s plan to dismantle the Affordable Care Act.

In his first press conference as President-elect, Trump reiterated his campaign promise to repeal and replace the ACA. Both Speaker of the House Paul Ryan (R-Wis.) and Senate Majority Leader Mitch McConnell (R-Ky.) said that dismantling President Obama’s healthcare plan will be one of the first tasks of Congress next year.

While who will lead the effort to replace Obamacare with Trumpcare is to be determined, the point person could be on the winning GOP ticket. “I wouldn't be surprised if Mike Pence got this in his lap. He knows the issues and has a feel for them. This could well be tossed over to the VP and his staff underneath that,” says Tom Miller, resident fellow at the American Enterprise Institute, where he studies healthcare policy and alternatives to the ACA.

Bloomberg/file photo

Miller points to the future vice president’s political and healthcare experience. “Not just because he is a governor, he worked on the Medicaid waiver for Indiana and it has a model that is consistent for what they have said on the HSA side,” he says.

He adds, “Pence also has experience on health policy so he is tuned into the Hill, plus he is a smart fit.”

However, who will ultimately lead the effort is still tough to call because, as Miller puts it, “We don't have a model of governance for a President Trump.”

Miller adds, “There are things you can do and order as a CEO as opposed to the difficulties of governance in the political sphere.”

According to Bob Laszewski, president of Health Policy and Strategy Associates, “Trump and Pence repeatedly made it clear that Obamacare would be repealed and replaced. They now have a mandate to do it and their supporters expect results. No Republican is going to stand in front of this freight train.”

It’s also possible Trump may give the ACA repeal mission to a former GOP primary rival, retired neurosurgeon Dr. Ben Carson, who has offered his services to the Trump transition team.

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The retired doctor told Politico today, “I think the replacement obviously must come first and it must be something that is very appealing and easy to understand. And then, only then, would you dismantle what’s in place.”

When asked if he expects to play a role in the new healthcare plan, Carson said, “Yes, of course.”

But some observers see another role for Carson. “I would have thought Surgeon General is where he would have slotted Dr. Carson, but others have suggested maybe an HHS post for him,” says Diane Boyle, senior vice president of government relations at the National Association of Insurance & Financial Advisors.

More options
Given Trump’s limited exposure to details and the players in healthcare policy, the President-elect could turn to the business world for his cabinet.

“My guess is there are business people Trump has dealt with who sound like they know something about healthcare and have run a few things and are willing to swallow some of the rhetorical excesses on this front. [They can] say, ‘I can do that,’ and then you would find some quasi-businessman propped up for Health and Human Services secretary,” says Miller.

He adds, “Governors aren't usually great administrators. This is not the first appointment you are thinking about.”

Also see: "'Every element' of Obamacare to be challenged after Trump victory."

Ronnell Nolan, president & CEO, Health Agents for America, is looking to Congress to take on Trumpcare. “Sens. Bill Cassidy and Congressman [Pete] Sessions have The World’s Greatest Healthcare Plan [Act of 2016]. They have that out and I’m going to have a call with them next week about what their strategy is bringing their plan to Trump,” says Nolan. “It’s the kind of plan that gives you the option of the ACA or [an alternative].”

But, bottom line, says Tom Scully, general partner with Welsh, Carson, Anderson & Stowe, a private equity firm that deals with healthcare, “I don’t think anyone has a clue yet. If they say they do they are making it up.”

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