What Trump’s victory means for healthcare: Industry leaders sound off

In January, Donald Trump will become the 45^th president of the United States. We asked healthcare policy analysts and industry leaders to weigh in. Here, they share reactions to the election results, and how the results could impact healthcare moving forward.

Joel V. Brill, MD, chief medical officer, Predictive Health, LLC, Managed Healthcare Executive Editorial Advisor:“For plans that have invested in Medicaid and/or exchanges, the next few months will be nail biting time.  For patients, will they continue to sign up, knowing that parts of the ACA will be under attack come January?”Read his full commentary.

Jon Kingsdale, PhD, managing director at Wakely Consulting Group, associate professor at Boston University School of Public Health: “House Republicans will repeal Obamacare on Day 1 of Trump’s presidency-how could they not!-but everyone understands that replacing it is far tougher. Republicans may well tear each other apart trying to decide whether and, if so, how to replace the ACA.”Read his full commentary.

Don Hall, principal, Delta Sigma LLC, Managed Healthcare Executive editorial advisor, former health plan CEO: “Given that the Republicans now effectively control all three branches of the government (since they will replace the vacancy on the Supreme Court) they are now in a position to have to offer solutions to the ACA rather than simple symbolically oppose it.”Read his full commentary.

Perry Cohen, chief executive officer, The Pharmacy Group, Managed Healthcare Executive editorial advisor: “The election results of Donald Trump as the new president signals for the healthcare industry that the power will move from not for profit healthcare to for-profit healthcare companies.”Read his full commentary.

Antoinette Kraus, founding director of the Pennsylvania Health Access Network: “We ... are going to continue to fight and support the ACA on behalf of the millions of Americans whose lives depend on it.”Read her full commentary.

“For plans that have invested in Medicaid and/or exchanges, the next few months will be nail biting time.  For patients, will they continue to sign up, knowing that parts of the ACA will be under attack come January?”

- Joel V. Brill, MD, chief medical officer, Predictive Health, LLC, Managed Healthcare Executive Editorial Advisor

BrillThe president-elect has said “Obamacare is a disaster. You know it. We all know it … We have to repeal it, and replace it with something absolutely much less expensive."

He’s outlined his proposals.  He could embrace what House Speaker Paul Ryan, Sen. Bill Cassidy, and others have proposed.  He could give tax breaks to encourage people to buy insurance while taking away the mandate to buy insurance.

Remember that MACRA was passed with bipartisan support.  The changes to physician payment aren’t going away; whether the regulatory burden will change remains to be seen.  Trump could continue to promote free-market solutions to delivering high value, effective and efficient care. The costs of healthcare are rising, and everybody (doctors, hospitals, labs, pharmaceuticals, medical devices, ancillary providers, plans, etc.) will be under scrutiny to show that they deliver value.

What does this mean for managed care?

For plans that have invested in Medicaid and/or exchanges, the next few months will be nail biting time.  For patients, will they continue to sign up, knowing that parts of the ACA will be under attack come January?

It should be interesting, to say the least.

“House Republicans will repeal Obamacare on Day 1 of Trump’s presidency-how could they not!-but everyone understands that replacing it is far tougher. Republicans may well tear each other apart trying to decide whether and, if so, how to replace the ACA.”

- Jon Kingsdale, PhD, managing director at Wakely Consulting Group, associate professor at Boston University School of Public Health

KingsdaleFirst, House Republicans will repeal Obamacare on Day 1 of Trump’s presidency-how could they not!-but everyone understands that replacing it is far tougher. Republicans may well tear each other apart trying to decide whether and, if so, how to replace the ACA.

After all, the politics of reducing coverage quickly are pretty off-putting and the clout of interest groups that would be hurt is tremendous. Moreover, if there has been any real work on a conservative consensus model for maintaining coverage gains while substantially reducing the federal role, we haven’t seen it.

Even a “simple” repeal at the end of the 2017 open enrollment period and before a new Secretary of HHS has been confirmed, would take some time to implement. To buy a little time, and build a good narrative for eventually resorting to "budget reconciliation" as the legislative vehicle for overcoming a Senate filibuster, Republicans may not fight to overcome a Democratic filibuster of the House's repeal bill.

This way, they can claim credit for immediate efforts to repeal, blame the Democrats and Washington for gridlock, and use the first six months of 2017 to hammer out some sort of plan for replacing the ACA.

Second, the range of replacement options is wide open-from total repeal (except for most of the Medicare savings, which House Speaker Paul Ryan already built into his budget plan, and a near doubling of the uninsured by 2018 (per Rand/Commonwealth Fund analysis, September 2016), to a more or less “token repeal.” The latter would repeal the ACA, and re-enact many parts of it, except for the Cadillac tax, the employer mandate, small-group market reforms, the device tax, and a few other "marginal" provisions.

Third, I doubt that anyone (including the president-elect) knows what will happen on health reform, but a conservative alternative to the ACA that attempts to maintain some coverage gains could include:

A. Replacing the individual mandate with pricing incentives (a la Medicare Part D);

B. Block-granting Medicaid (another Ryan favorite);

C. Eliminating market reforms for small-group coverage and scaling them back for individual coverage (e.g. moving from 1- -3 to a 1- 5 adjusted community rating premium range, and allowing each state to define essential health benefits for itself); and

D. Replacing advanced premium tax credits and cost sharing reductions with tax credits (a la John McCain) and HSAs.

However, all predictions are uneducated guesses!

“Given that the Republicans now effectively control all three branches of the government (since they will replace the vacancy on the Supreme Court) they are now in a position to have to offer solutions to the ACA rather than simple symbolically oppose it.”

- Don Hall, principal, Delta Sigma LLC, Managed Healthcare Executive editorial advisor, former health plan CEO

HallThe election of Donald Trump will create a great deal of uncertainty in the healthcare arena. He has no background with any aspect of healthcare and the few times he’s mentioned it has been to say that he would repeal and replace the ACA.

Given that the Republicans now effectively control all three branches of the government (since they will replace the vacancy on the Supreme Court) they are now in a position to have to offer solutions to the ACA rather than simple symbolically oppose it.

I believe that much of the ACA will remain intact, particularly the 80% that is working and often not discussed. But the exchanges, and how plans are offered through them, will be tweaked in a way that removes the Obamacare label.

The Medicaid expansions will likely be replaced with block grants and requirements for cost sharing and perhaps work requirements for Medicaid recipients.

In a long shot I think that a Medicare buy-in provision allowing people as young as 50 or 55 may be adopted as a means of both addressing the uninsured problem as well as to provide some additional solvency to the program.

The State Children’s Health Insurance Program, up for its second 10-year reauthorization this year, will likely win approval but may have a number of additional amendments added.

At the end of the day I don’t foresee a significant negative impact on the healthcare market with Trump’s election, but some serious course changes.

“The election results of Donald Trump as the new president signals for the healthcare industry that the power will move from not for profit healthcare to for-profit healthcare companies.”

Perry Cohen, chief executive officer, The Pharmacy Group, Managed Healthcare Executive editorial advisor

CohenThe election results of Donald Trump as the new president signals for the healthcare industry that the power will move from not for profit healthcare to for-profit healthcare companies.

Publically held companies (e.g., health insurers, drug companies, PBMs, etc.) will have more influence in the marketplace versus locally based not for profit organizations (e.g., Blue Cross Blue Shield plans, regional health plans, hospitals and community clinics).

Federally funded initiatives to move healthcare from volume to value will disappear.

Also, the federal subsidies that exist to help people purchase health insurance will be gone.

The next four years should be interesting.

“We at the Pennsylvania Health Access Network are going to continue to fight and support the ACA on behalf of the millions of Americans whose lives depend on it.”

Antoinette Kraus, founding director of the Pennsylvania Health Access Network

KrausGiven the election results, we know there is a lot of uncertainty about the status of the Affordable Care Act.

But there is one thing we can be certain of: 20 million Americans and over 1.1 million Pennsylvanians have gained health insurance through the ACA, and millions more still need it.

Those who have called for “repeal and replace” of the law have put forward hollow plans that would: 

• Leave 20 million people without health coverage,

• Put 130 million people with pre-existing conditions back at the mercy of insurance companies and at risk of losing coverage,

• Allow insurance companies to charge women more than men,

• Prevent young adults from staying on their parents’ plans until age 26

• End access to no-cost, life-saving preventive services like mammograms and cholesterol screenings.

We at the Pennsylvania Health Access Network are going to continue to fight and support the ACA on behalf of the millions of Americans whose lives depend on it. We hear from these people every day. They are our families, neighbors, coworkers and community members.