Donald Trump's presidency will almost certainly lead to major changes for healthcare—but not necessarily for individual doctors, and probably not right away.
Trump’s best-known pledge regarding healthcare is to speedily repeal and replace the Affordable Care Act (ACA). But completely undoing the law could take years and will encounter fierce resistance both in and outside of Congress. For example, in early December a coalition of hospital groups warned that ACA repeal could “decimate hospitals’ ability to provide services, weaken local economies and result in massive job losses.”
Further reading: GOP Obamacare replacement bill puts physicians, patients in charge
And even repeal of the law probably won’t significantly change most aspects of healthcare delivery, says Russell Libby, MD, a board member of the doctors’ advocacy group The Physicians Foundation and a pediatrician practicing in Virginia.
“I think repeal and replace is a political statement, not necessarily a practical one,” says Libby. “The care that is being provided to a lot of people in this country depends on evolutions that have happened since the ACA was implemented, and it’s going to be delicate to dismantle.”
Libby cites the law’s promotion of new practice and payment models and the growing emphasis on team-based care as trends that are unlikely to change. “We’ve moved into a phase that I think is really irreversible and looks much more at what’s important to patients and how best to serve them,” he says. “And ultimately that’s what best serves healthcare and our profession.”
In addition to the ACA pledge, the Trump campaign’s website offers a few other clues about the new administration’s goals in the healthcare arena. Among these are:
- “modernizing Medicare”—a widely-accepted euphemism for some form of privatization/premium support program
- allowing insurance companies to sell healthcare policies across state lines
- adopting policies that will make it easier for patients to open health savings accounts (HSAs) to pay their medical expenses
- making it easier for pharmaceutical companies to bring new drugs to market
- “maximizing flexibility for States in administering Medicaid”—which means converting Medicaid funding into block grants to states
Trump has also announced his choices for two positions that are key for developing and implementing healthcare policy. His nominee for secretary of the U.S. Department of Health and Human Services is Tom Price, MD, a U.S. representative from Georgia, former orthopedic surgeon, outspoken critic of the ACA and supporter of Medicare privatization.
For administrator of the Centers for Medicare & Medicaid Services, Trump plans to nominate Seema Verma, MPH, president and CEO of SVC Inc., a health policy consulting firm headquartered in Indianapolis. Verma helped design plans for states that initially declined to expand Medicaid coverage following passage of the ACA.
These plans generally include some form of financial contribution or work requirements for Medicaid beneficiaries. One such plan was implemented by Indiana governor, and now vice president-elect, Mike Pence.
With the caveat that nothing is yet certain, here’s a look at how some issues of importance to primary care doctors might unfold during the Trump administration.
01/ The Affordable Care Act
As noted above, Trump has frequently promised to repeal the law and replace it with a system providing Americans with “great healthcare at a fraction of the cost.” But how and when repeal occurs remained open questions before the new administration took office.
In early December, for example, several influential Republican senators said they would make a vote on ACA repeal their first order of business after Trump’s inauguration, but delay the actual repeal for as long as three years. During that time, they and the Trump administration would work to develop a replacement for the ACA.