Implications of Donald Trump on Healthcare
While the implications of the election will play out over the next few years, it is worth discussing an overview of how changes will impact healthcare providers. President-elect, Donald Trump offered changes to the Affordable Care Act during his campaign:
1.) Repeal the Affordable Care Act
“Obamacare is a disaster.” Spoken by President-elect, Donald Trump during his campaign. Earlier in January, Congress partially repealed the ACA through a bill (HR 3762), ultimately it was vetoed by President Obama. This suggests that some of the key features of HR 3762 are likely to shape action including:
-Phasing out funding for subsidies to low/middle-income individuals to afford insurance through healthcare exchanges.
-Restricting the federal government from operating health insurance exchanges.
-Eliminating tax penalties for individuals who do not purchase health insurance and for those that employers with 50 or more employers.
-Phasing out Medicaid expansion.
Impact of repeal
The impact of the repeal in full was studied by the Robert Wood Johnson Foundation in June of 2016. They concluded that federal spending on the non-elderly would decline by $927B between 2017 and 2028. The number of uninsured people would rise by 24 million by 2021. Significantly less healthcare would be provided to modest and low income families.
2.) Sale of Health Insurance across state lines
This is consistent with the House Republican Health Care Task Force in June 2016 which wanted to enable consumers to purchase plans offered in states other than their own thereby promoting competition among plans and lowering premiums.
3.) Medicaid transformation into a block-grant program
The Congressional Budget Office estimates that the elimination of Medicaid expansion alone will reduce Medicaid enrollment by 14 million. Furthermore, programs such as 1115 Medicaid Waiver and DSRIP initiatives will likely cease.
It has been indicated that the Medicare Access and CHIP Reauthorization Act (MACRA) will likely continue uninterrupted (we highlighted this in our last article). While the ACA and MACRA are both vehicles to drive value-based purchasing, MACRA will likely remain.
House Speaker, Paul Ryan has articulated the need to reform Medicare by moving it to a voucher system, a privatization vehicle. Medicare privatization is high on the party’s list.
So what do we today?
1.) Good governance. Over the next year to two years, Providers will be undergoing several changes and implications of a move towards consumer-centric and retail-driven market.
2.) We must therefore, focus on operational efficiency and quality improvement.
3.) A consumer focus with price transparency.
4.) Alignment of the care continuum; provider, hospital and payer.
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