While much about a Trump presidency remains relatively unclear, one thing is for certain: The way health care is handled in the U.S. today will most certainly undergo a major transformation. From medical research to the delivery of care to patients, much may change under the new administration. It is very likely that the Trump administration will have to address these issues soon after inauguration. How the president-elect and Congress deal with health care may define the next four years.
The Affordable Care Act is in jeopardy and needs Congressional action in order to save it — premiums are rising, insurers are leaving the exchanges and patients are left with higher costs and less choice.
In addition, academic researchers from all around the country also are becoming concerned about the future of research funding from the prestigious National Institutes of Health. The NIH has funded research for over 100 years with the goal of advancement in treatments for a multiplicity of diseases — NIH grants are some of the most sought after funding sources in academic medicine, and many talented scientists depend on this funding in order to conduct experiments that have the potential to substantially advance our understanding of disease.
One of Mr. Trump’s biggest issues on the campaign trail was his promise to “repeal and replace” Obamacare. Millions of Americans are in the process of re-enrolling in the ACA exchanges. However, the law faces numerous challenges, including rising costs and diminishing choice — many areas of the country have only one choice for insurance provider in the exchange since large insurers such Humana, United and Aetna have pulled out due to staggering financial losses. Fewer physicians are accepting exchange insurance due to very low reimbursement rates. Patients — like us — are caught in the middle with little choice. Many are “functionally uninsured,” as they have limited access and high copays.
Will President-Elect Trump Keep Anything From Obamacare?
Based on his most recent comments to the media, it appears Mr. Trump will keep at least two things from the ACA in place. One very important provision I expect to remain in any new legislation is the mandate that ensures those with pre-existing conditions will remain insured. If we do not keep this provision, we’ll revert to the days when insurers could discriminate against individuals with chronic medical problems by either denying coverage or making coverage far too expensive. It’s essential this stay in place to make sure all Americans are covered (in an affordable way) — regardless of what chronic medical problems they may have.
Mr. Trump has also indicated he’ll keep the provision that allows young adults to stay on their parents’ plans through age 26. I think this, too, is vital. Young adults are building careers and often scraping by financially while they complete higher education and low-paying internship training programs. Allowing these individuals to stay on their parents’ plans only makes sense. It alleviates a significant financial burden while they’re developing careers and working toward education goals in order to make significant contributions to society.
Beyond these two items, I don’t expect Mr. Trump to keep anything else from the ACA. The Republicans — under Speaker Paul Ryan’s leadership — have drafted a plan and made it available online. Many of the ideas in this plan appear quite consistent with what Mr. Trump outlined. However, no matter what plan is actually finalized, we must have cooperation between parties as well as between the different branches of our federal government to be successful.
[See: 5 Common Preventable Medical Errors.]
So, What’s Likely to Change in Health Care?
This is where the water gets murky. Trump has said numerous times that he’ll “repeal and replace” Obamacare, but that may be difficult from a legislative standpoint given the simple majority in the Senate. Currently, it will take 61 votes in the Senate to repeal the legislation. Based on the partisan politics we’re likely to see in Congress under the new administration, this is unlikely to happen. We’re more likely to see changes to the current law without a full repeal. Alternatively, a President Trump could choose to “starve the ACA” by signing a bill similar to the one that was sent to Obama a few years ago that essentially de-funded the ACA. (Obama vetoed that bill, and there was no attempt at an override due to the balance of power in the Senate).
There are also other ways that the law can be dismantled. Over the last year, President Obama has been using Treasury monies that were meant for tax refunds to pay back insurers in the exchanges that have high-cost patients. While the ACA legislation has provided for these payments in the past, Congress did not fund this provision in the current budget — so Obama has been re-appropriating money from other sources to entice insurers to remain in the exchanges. There is a court case pending that is likely to stop this action. However, Trump can stop it immediately on January 20th by no longer authorizing these payments. If this happens, I worry more insurers are likely to pull out of the exchanges, and the ACA will continue to slowly implode. Ultimately, patients will suffer.
[See: Top Reasons Children End Up in the Hospital.]
Are There Any Specifics From Trump’s Plan for Health Care That We Can Expect?
While it’s likely any plan will involve the Republican/Ryan proposal that has been crafted for more than a year, Mr. Trump has discussed a few specifics during the course of the campaign. It’s unclear at this point just how much of this will be implemented. Here are a few of his proposals and their potential implications:
Allow insurers to sell insurance across state lines. By allowing free market competition, Trump argues competition for patients by insurance companies will lead to better service, lower prices and more patient satisfaction.
Allow individuals to deduct health care premiums from taxes. By putting more money in individual pockets through tax savings, patients will be better able to afford health care.
Allow individuals to set up health care savings accounts, tax-free money. This refers to “super-charged” tax-free accumulation for health care spending.
The individual mandate will be eliminated, as well as the employer mandate. Individuals will no longer be penalized for choosing not to purchase insurance. This may lead to funding difficulties, as the ACA was built around the concept of the “well” paying for those who require more expensive health care resources.
Price transparency for doctors and hospitals. Prices for common surgeries and services vary widely by geography and hospital. By requiring transparency, patients can shop around, using both quality and price data to determine the best place for them. This will prevent gouging by certain hospital systems.
Begin a “block grant” to states to deal with Medicaid. The federal government would send money to the states. It would then be up to the states how to use the money to cover the citizens. This may not be good; in some states, it’s likely to lead to decreased payments to doctors and hospitals and may leave more low-income Americans without adequate care.
Streamline the Food and Drug Administration, and allow Americans to purchase prescription drugs from other countries. The U.S. pays far too much for drugs that can be obtained in Canada and elsewhere for much less. Why should the U.S. pay all the research and development costs for the world?
Privatize Medicare, along with other Medicare changes. For example, provide citizens with a choice. Use Medicare dollars to see a Medicare doctor, or use that money to pay for a private doctor who does not take Medicare. However, this may result in more out-of-pocket expenses for seniors.
Allow Medicare to negotiate drug prices. This will lead to lower costs to federally-sponsored health care plans.
[See: How to Help Aging Parents Manage Medications.]
What’s the Bottom Line for the Everyday American?
Time will tell — this is a very unusual point in American history, and what happens in the next four years could potentially fundamentally change health care in the U.S. for decades to come. Ultimately, we must put a health care plan in place that will cover all Americans, and we must make sure the plan allows for low costs and easy access.
However, this won’t be a quick fix. Our leaders, both Democrats and Republicans, must work carefully to put a sensible, financially sound, effective health care system in place, and they must do so in a way that ensures a smooth transition of insurance and care. If there is no good replacement plan, I’m concerned there may be 25 million newly uninsured Americans. (Though while listed as insured, many of these people are functionally uninsured due to limited access, high copays and premiums and deductibles.) It’s my hope that Congress will work quickly to craft a fiscally responsible health care plan that works for all Americans and allows doctors to be healers once again.
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