Five healthcare policies to expect under President Trump

As Donald Trump was sworn in as the 45^th U.S. president, health policy experts share with Managed Healthcare Executive what’s next for healthcare.

Renick

“Nearly every president since World War II has attempted to influence and improve healthcare, and the recurring theme tends to be expanded access and affordability, with an increasing focus on quality in recent decades,” says Dan Renick, RPh, president, Precision for Value.

“President Trump appears poised to attempt similar given his campaign focus on repealing and replacing Obamacare, but changes will likely be more measured than massive, even with a legal repeal of the Affordable Care Act [ACA],” Renick says. “The theme that this administration will likely expand on significantly is value demonstration, including payment reforms, that effectively incorporate value into fair reimbursement.”

Here are 5 things to expect:

1. Focus on ACA repeal with a longer rollout of replacement policies. “The Administration’s principal healthcare agenda will be to roll back policies of the ACA,” says Anders Gilberg, senior vice president, government affairs, Medical Group Management Association (MGMA). “But replacement will prove to be a difficult balancing act between preservation of popular policies and the desire of Congress to do so in a fiscally conservative manner.”

Hutt

As this is a big undertaking, Matthew Hutt, CPA, CGMA, partner, AAFCPAs in Boston, doesn’t expect to see changes overnight. “We expect that they will keep the things that people generally like, such as kids being able to maintain coverage on their parents’ plan until they are 26, and coverage for Americans with a pre-existing condition-both did not exist before Obamacare,” Hutt says. “Even if the ACA is modified, the model will still likely follow quality versus quantity when it comes to reimbursements. The fee for patient care will be paid for as a shared responsibility for the patient’s overall healthcare. This is a widely accepted methodology to control the costs of healthcare, and to ensure long-term care recovery and better clinical outcomes.”

Along with the effort to retain popular aspects of the ACA, new measures will be introduced that attempt to further expand coverage “given that 30 million Americans remain uninsured, expand the healthcare provider base to adequately provide needed care, especially primary care, and foster increased competition across healthcare to pressure price and improve quality,” Renick says.

Portela

The challenge for the former president Obama was that his plan relied heavily on his initial pick for Secretary of Health and Human Services, Senator Tom Daschle, according to Alan Portela, CEO at AirStrip. "Not getting his pick created a domino effect that ended up with poor execution and losing the election for the Democrats," Portela says. "Today, we have a president that has serious business experience and is known for his ability to execute and create strong teams around him. Repealing Obamacare and offering a comprehensive replacement plan will depend on the ability to have Rep. Tom Price’s nomination approved as the first doctor to run HHS since 1992, and close collaboration with Speaker of the House Paul Ryan."

Next: Reduce the administrative burden

Gilberg

2.   Opportunities to reduce the administrative burden on medical practices in an overall deregulatory policy environment. “MGMA will actively seek new opportunities to reduce the administrative burden on medical practices in what we expect to be a deregulatory policy environment,” Gilberg says.

3. Focus on insurance costs. Hutt expects to see the biggest changes with how federally-funded Medicaid and Medicare are reimbursed. 

“For example, there is discussion of changing Medicaid into a block grant, or federal lump-sum payment to states,” Hutt says. “This would put in each state’s hands the decision of how to spend that money and disperse amongst those who need it. This could potentially result in reductions in payments to the states, requiring that states budget for, or opt not to supplement the difference. Block grants could impact reimbursements to providers, and lead to cuts in service/coverage to people.”

4. More focus on value demonstration and related payment schemes, which in many cases are outdated and not well suited for the medical innovations of today and tomorrow, according to Renick-"innovations that more and more frequently will reverse or cure devastating diseases and likely need to be paid for over several years, much like mortgages enable a healthy housing market,” he says. 

5. Precision medicine made possible by strengthening cybersecurity and interoperability. "As we enter a new era in politics, we have an opportunity to focus on two areas of healthcare that have not received the needed attention," says Portela. "That is a mistake that needs to be rectified going forward. It is time to recognize the crucial importance of interoperability in support of value-based reimbursement incentive programs, and recognize the true threat that exists to our healthcare system around cyberterrorism. We need to build upon the current interoperability roadmap and encourage legacy vendors to open up their data and increase requirements around cybersecurity, ultimately creating a path to personalized medicine."