After 18 months that felt like an eternity, the most contentious election in recent memory has finally come to an end. The results are in and the voters have spoken: On January 20, 2017, Donald Trump will be sworn in as the 45thPresident of the United States.
Buckle up folks, changes are coming. Having said that, Donald Trump is nothing if not unpredictable, so it’s a little tricky to hone in on exactly what he’s going to want – or be able – to accomplish. During his campaign, he was vague on the details of his plan for healthcare. There was no appointed healthcare policy spokesperson on the Trump team. This befuddled many healthcare executives whom I know and who carry a lot of influence in Washington, D.C. Based on what we do know, here’s my quick take on what the healthcare industry can expect to see from the Trump Administration:
- The Affordable Care Act. Trump made throwing out the Affordable Care Act a central pledge of his campaign, though he never articulated a clear replacement option. However, I confidently predict the overthrow of the ACA will not occur. Why? There aren’t 60 senators who will do that. Not over the next two years anyway. While his promise to repeal Obamacare clearly worked to motivate his voters, President Trump’s real focus is on the section of the law creating the “individual mandate.” There are also real issues with other sections of this complicated 2,000-page law. More than a few Democratic leaders recognize that the ACA needs mending. Mark Cuban, the bold-talking entrepreneur, said it best: newly launched initiatives of this magnitude are expected to have glitches and require follow up fixes. Thus, I expect his Administration will rely on congressional Republicans to work on pushing through a series of “free-market fixes.” These could include repealing taxes on medical devices, restricting medical malpractice liability, and allowing insurance to be sold across state lines. A bigger task would be legislating the ability for consumers to access to foreign markets for lower-priced brand prescription drugs, and by permitting CMS to bargain on price directly with big pharma. At the end of the day, expect incremental change, not wholesale change.
- Value-based care. Trump never showed much interest in the intricacies of healthcare policy during his campaign. Now that he’s President, don’t expect that to change. Instead, look to Congress to shoulder much of the work. The Senate has shown welcome signs of a bipartisan focus on using market incentives to reward clinicians for providing quality over quantity. For example, just two weeks ago a working group made up of Senators from both sides of the aisle released draft legislation called the Chronic Care Act. According to The Hill, the bill is meant to create or expand a host of programs aimed at making Medicare more efficient and saving money in the long run. And, of course, we have the Republican and Democratic endorsed MACRA going into effect on January 1, 2017 that contains new payment models for helping providers share in full risk, heralding a return to stronger physician- patient relationships.
In summary, we have a new President come January. I believe healthcare policy will face incremental changes, not wholesale overhaul, through the Republican controlled Congress and Executive branch. Thankfully, bi-partisan cooperation will continue on things that matter, such as reimbursement policy. I think Congress understands that value-based care is the future and its task is to find and pull the levers that will incentivize providers, payers and consumers to continue the shift away from fee for service to value based reimbursement models. Let’s keep America strong.
(Image via donkeyhotey, Flickr)