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Health Care in a Trump Presidency

UH Clinical Update - December 2016

By Cliff Megerian, MD, President, University Hospitals Physician Services

A notable promise that Donald Trump made as a candidate was to repeal and replace the Affordable Care Act (ACA). This naturally raises the question – and concern -- of how his presidency will affect the health care industry and University Hospitals. 

During his campaign, Mr. Trump said that repealing and replacing the ACA will be a priority for his first 100 days as president. However, as the past experience has repeatedly shown, nothing happens quickly at the federal level of government.

Even if President Trump made this one of his first actions after his January inauguration, it simply isn’t possible to quickly dismantle, let alone replace, anything as comprehensive as the ACA. In fact, his election has spurred tens of thousands more people to sign up for ACA coverage and select a plan for 2017. So we have a fairly good idea that no major changes will occur until 2018, at the soonest.

Replacing the ACA is an extremely complex initiative. You might recall how long it took for the Obama administration to put it in place, and the technological glitches encountered by those wanting to sign up in the first few months.

Yet eventually, 20 million people who were formerly uninsured were able to get health insurance under this 2010 health-reform law. Closer to home, in Ohio, the number of uninsured people fell from 1.3 million to 400,000.

Consider, too, at both the state and federal levels, there are contractual obligations with health insurance companies to provide this coverage – and these contracts must be honored for their duration.

There’s no doubt that a Trump presidency creates a huge deal of uncertainty for the health care industry and the patients this industry serves. But it is worth noting that uncertainty would also be an issue had Hillary Clinton been elected, especially if she had faced a Republican House and Senate.

Let’s also remember that health care (like most industries) has nearly always existed amid major uncertainty. Over the years, major initiatives, such as the creation of Medicare and Medicaid in the 1960s and the move toward HMOs in the 1990s, altered the landscape.

We do know that the president-elect considers some aspects of the ACA worth keeping. He is in favor of children age 26 and under being covered by a parent’s health insurance, as well as insurance companies being prohibited from denying people health insurance based on a pre-existing condition. He has spoken in favor of allowing health insurance companies to do business across state lines, therefore increasing competition, which could lead to lower premiums. President-elect Trump has also said he’d like to negotiate reductions in the prices of drugs with pharmaceutical companies.

Regardless of what the new president plans, a repeal and replacement of the ACA would have to pass muster with Congress. No doubt many members of the House and Senate have their own ideas of what “health care reform” should mean. Thousands of details would have to be hashed out, and then the new plan would have to garner enough votes for passage.

In addition to overhauling how people buy policies, the plan might include a makeover of Medicaid, and possibly even Medicare, the latter of which has been proposed by Rep. Paul Ryan, the Speaker of the House. 
Larry Levitt, a senior executive with the non-profit Kaiser Family Foundation, has noted that most insurers will need time to adjust – again -- to any new playing field, even if it means going back to what they were doing before the law was passed. “Unwinding creates just as much disruption in reverse,” Levitt said.

And one important note: MACRA, the massive physician reimbursement overhaul law, is not part of the ACA. It will have to be addressed separately.

That said, knowing that there will almost certainly be huge changes to health care policy in the U.S. is unsettling. During this time, it’s important to remember that throughout the many changes in the past several decades, the U.S. health care system has continued to be one of the best in the world.

At UH, our emphasis will not change. We remain committed to providing the highest-quality care to our patients.