One week ago today, the United States woke up to the news that Donald Trump (R) had been elected President of the United States. As people took in that information, questions around policy began to emerge. Among one of the bigger policies in question remains the details of Trump's plans for the healthcare industry.
On the campaign trail, Trump didn't mince words on the Affordable Care Act, calling it a "disaster." With a GOP-led Congress and a member of the Republican Party in the Oval Office, it's widely assumed President Barack Obama's signature law would be in the GOP's crosshairs.
But the insurance industry is just one part of healthcare. The website doesn't answer what a Trump administration thinks about funding for the National Institutes of Health, which could affect Cancer Moonshot efforts. Nor does it answer what's Trump's take on the value-based payment reforms such as the bipartisan MACRA payment rules.
The big questions
Last week, Healthcare Dive asked readers to tell us what they'll be watching for in a Trump administration. The biggest question readers had is no surprise: What will happen to the ACA under a Trump presidency? If so, will there be a transition period so the market can react? And to that end, will pre-existing conditions still be covered if the legislation is reformed?
Trump's website recently posted some bullet points as an outline for his healthcare plans. He touted a hard line "repeal and replace" message while campaigning though late last week Trump did concede to The Wall Street Journal the ACA "will be amended, or repealed and replaced." In the same interview, he stated he likes the portions that prohibit coverage based on pre-existing conditions and that allow children to stay on their parent's policies until they turn 26.
However, cherry-picking provisions in the ACA may not be in the cards as a real prospect. The ability to ban insurers' from denying claims based on a pre-existing condition hinges on having a large enough number of healthy individuals to balance out the risk pools. That's where the individual mandate came in to push young, healthy individuals into getting insurance. Though some have noted the individual mandate doesn't have enough bite to push the necessary amount of young people into buying policies, which has helped contribute to those higher premium rates you've been so much hearing about. As is everything in healthcare, it's complicated. Without a detailed plan from Trump, it's hard to see exactly what will be done to the ACA but there are a couple of scenarios how Trump may attempt to repeal and replace the ACA.
Who will helm HHS?
Readers wanted to know who will lead the charge at HHS. Rumors have been circling and filling up a fair share of our Twitter feed thanks to our Washington Twitter follows and action will undoubtedly move fast. On Tuesday, for example, Ben Carson, a potential HHS secretary candidate, stated he had no interest in serving in a Trump administration.Throughout the day Bobby Jindal was rumored to be up for the job while Rep. Tom Price's name was tossed around toward the end of the day. Politico reported this morning a Trump transition aide said the transition team "will land at key executive agencies 'imminently,' possibly as early as Friday."
More details, please
A lot of readers wanted to see more policy details for Trump's healthcare proposals. His campaign for the most part didn't stray far from the "repeal and replace" party line or how insurers should sell policies across state lines. Readers wanted to know how a Trump presidency would handle the following:
- Healthcare access to college-aged children;
- Balancing risk pools without individual mandates;
- Value-based payment programs such as MACRA;
- Medicaid expansion;
- Impact on essential health benefits for quality health plans;
- CMS Innovation Center's future;
- Population health definition;
- Women's health benefits; and
- Behavioral health policies.
In addition to questions, readers shared their reactions to a Trump administration. Some were gracious enough to let us post their responses:
"[A]s a medical billing company owner, I am anxious to see how it all plays out and what the changes will be because it will definitely affect my clients/providers and our industry as a whole. So far I have not been impressed with Obamacare at all…high premiums and deductibles mean patients still cannot afford medical care. Many patients signed up the first year, only to discover when they went to the doctor they still had to pay the entire allowed amount of the bill because they had such high deductibles. Many of them canceled or defaulted on paying premiums, which also left providers and insurers alike holding the bag and providing services for free." - Cheri Freeman, president of HRS Medical Billing
"Fixing [the ACA] should involve: 1) Keep the provision that does not allow the carriers to rate people due to pre-existing conditions. 2) Allow national coverage/bidding across state lines and/or use the federal employee plans and expand to those currently under Obamacare model. 3) We have GOT to allow Medicare to negotiate drug pricing and figure out a way to limit price gouging by the drug companies. We should not pay substantially more than Canada or European countries when it costs the same to manufacture." - Linda Peterson, founding principal/CEO at Executive Solutions for Healthcare
"The ACA has had some viable pieces. For rehab it has held therapists more accountable and not over utilizing services and it seems for some imaging services too. But I have also seen the statistics and numbers of insurance profits and it’s staggering. They are paying out way less, charging way more and the CEOs are profiting big time. In the mean time, I have my senior citizens not receiving care because they can’t afford it and, frankly, it makes me angry. I have the curse of seeing behind the scenes…the information the American people and consumers don’t see. That being said, without being too political, I hope our new administration can fix what actually needs to be fixed. I trust our new president to have the American citizens' best interest in mind instead of the big interests and big insurance. Big government has no place in our healthcare system and that has been evident. Those that do care and do contribute positively to our society – that take responsibility for their own health and their families health – have been left out in the cold. There needs to be a balance. That is my hope for our new administration." - Suzan Blake, office manager at Everson Physical Therapy