What will the Trump administration mean for medicine?


The Affordable Care Act is in the crosshairs as the transition to the Trump administration begins Nov. 9.

The primary tenet of Donald J. Trump’s health care platform calls for Congress to repeal the ACA.

Donald J. Trump Gage Skidmore/Wikimedia Commons/CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

Donald J. Trump

“On day 1 of the Trump administration, we will ask Congress to immediately deliver a full repeal of Obamacare,” according to the policy position on Mr. Trump’s campaign website. “We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden health care access, make health care more affordable, and improve the quality of the care available to all Americans.”

In fact, Mr. Trump has called for ACA repeal efforts to begin on his administration’s first day.

The Trump administration is likely to find plentiful allies in Congress as both the House and the Senate were projected at press time to have Republican majorities, albeit slim ones. Since the ACA’s passage in 2010, House Republicans have put forward repeal legislation scores of times.

While many medical specialty societies have supported the ACA and other major health care reforms enacted over the last 8 years – Meaningful Use from the HITECH ACT and value-based payment from MACRA among them – large numbers of physicians have chafed under the myriad reporting requirements and administrative hassles.

A recent survey commissioned by the Physicians Foundation and conducted by Merritt Hawkins found that nearly half (48%) of physicians are considering a change of practice – including leaving medicine – in the next 1-3 years. Reasons cited by survey respondents included the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) transition to value-based care, the increased coding required by ICD-10, the growth of physician employment, the continued sale of private practices to hospitals and health systems, the increased number of patients in the system because of the ACA coupled with a shortage of physicians, and the “businessification” of heath care.

“If any of these [changes] occurred in a period of time, it would be impactful,” Walker Ray, MD, president of the Physicians Foundation, said in an interview. “But to have all occur simultaneously, we say now that to be a physician is to feel the ground shaking under your feet. This is the landscape in which the survey was taken.”

Mr. Trump supports several free market reforms to replace repealed provisions of the ACA, as well as address other issues in the health care system. The proposals include the following:

• Foster interstate insurance sales.

• Reinstate the tax deductibility of health insurance premiums.

• Promote the more widespread use of health savings accounts.

• Require price transparency so that patients can shop for medical procedures, exams, and tests.

• Block grant Medicaid to the states.

• Allow patients to import drugs from outside of the United States.

The Trump platform also promises to reduce fraud and waste, as well as save approximately $11 billion annually by not providing health care to illegal immigrants.

Speculation has also begun regarding who might lead health care agencies and policy for the Trump administration. Among the names that have been floated for secretary of Health and Human Services are Ben Carson, MD, the former presidential candidate and retired neurosurgeon; former House Speaker Newt Gingrich (who also has been suggested as a potential secretary of State); as well as Florida Gov. Rick Scott, former chief executive of Columbia/HCA, according to Politico.com.

On Twitter @denisefulton

Gregory Twachtman contributed to this story.

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