Media outlets have spent the past few days theorizing about the potential implications.
Donald Trump’s ascent to the White House has caused ripples of doubt, uncertainty and mixed reactions among those in the healthcare industry. Trump has pledged to make healthcare reform one of his top priorities when he assumes office on January 20, and if he has his way, the Affordable Care Act will be papered over with a free market approach. This has executives, industry leaders and the general public wondering what the future of healthcare will hold.
Media outlets have spent the past few days theorizing about the potential implications. Here’s a snapshot of some of the current buzz:
Harvard Business Review
HBR has said that, during this period of uncertainty, there’s a risk that healthcare companies and providers will accelerate their mergers and acquisition activity in an effort to “bulk up” so they can sustain profits in the wake of whatever comes next. Some may consolidate to ensure that they’re too big to fail, and have leverage to dictate the policies that will govern their industries. This reaction, said HBR, could undermine efforts to build an efficient and high-quality health sector. It’s recommendation to Trump: Swiftly promote and protect competition at every level, and flush out the details of his policy agenda.
Some women are stocking up on IUDs and other forms of birth control in fear that ACA repeal would lead to contraception not be covered in full by their health insurance plans. But Time thinks they may be jumping the gun. Since Republicans do not have the 60-vote supermajority in the Senate to fully repeal the law, they likely would have to repeal parts of it through budget reconciliation. This could threaten the individual mandate, the employer mandate and the subsidies that make policies more affordable. Birth control, however, is considered preventative care, as are other aspects of women’s healthcare: breast pumps, mammograms, screenings for cervical cancer and the like. Cynthia Cox, associate director of the Kaiser Family Foundation, said a full repeal of the ACA would likely be necessary in order to affect that provision — which seems unlikely, at least for now.
However, Cox pointed out that for people on Medicaid, the preventive service coverage rule does affect the federal budget, which means birth control coverage for Medicaid beneficiaries could be halted.
Additionally, because the GOP’s plan would stop funding marketplace subsidies, plans purchased through the exchange would become much more expensive, and some women would likely opt out of health insurance coverage altogether — or be forced to pay more for care.
The President-elect has pledged to bring “much needed free market reforms to the healthcare industry.” Marketplace said this could mean giving hospitals, insurers and drug companies a freer hand to merge. That, the outlet speculated, could lead to less competition, and higher prices, for consumers.
Bloomberg notes that Trump’s 310-word plan, released on his website, contains language indicating opposition to abortions, saying it would protect “innocent human life from conception to natural death.” Not addressed in the plan is the rising cost of prescription drugs, which for the past year has been under intensifying scrutiny. It also doesn’t address the prospect of importing cheaper medicine from abroad, something for which Trump had previously indicated support.
Benjamin Isgur, a leader in the PwC Health Research Institute, told the Washington Post that hospitals and health systems have benefitted from the ACA, as they’re able to serve more people with insurance. But since the election, there’s been considerable uncertainty for hospitals. Hospital stocks were down, insurers; stock prices were mixed, while pharmaceutical and biotech companies got a big bump.
Investors saw the election as a respite from the pressure on drug prices, even though Trump has suggested that Medicare should be able to negotiate drug prices, a policy the pharmaceutical industry opposes.
The LA Times suggested that while it may be relatively easy to roll back the Affordable Care Act, full-on repeal may be a trickier proposition. Largely, that’s because congressional Republicans have never advanced replacement bills through an arduous committee process, submitted the legislation to robust budgetary analysis or contended with the impact to constituents, who could see out-of-pocket medical costs skyrocket.
The publication called such a large-scale rollback of government benefits “unprecedented,” and noted that several activist groups were already mobilizing to defend the ACA’s coverage expansion.
Trump’s website states that he will ask Congress to repeal the ACA on day one of his administration, but ABC doubts that this is actually possible. For full repeal, the Senate would need to pass a measure with 60 votes, which Republicans currently do not have. Reconciliation, which could chip away at the law, only needs 51 votes, but ABC speculates that probably won’t happen during the first 100 days, as it’s a lengthy and tedious process.
Crain’s Chicago Business
With Trump’s victory assuring a conservative majority on the Supreme Court, Crain’s speculated that this may mean a rollback in abortion rights for women. It also means, the publication said, that the U.S. Justice Department and Federal Trade Commission may look more favorable on mergers and consolidation in the healthcare industry.
The healthcare leaders surveyed said they were not prepared or eager for the changes to come, with chief executives overwhelmingly backing the ACA and its push from fee-for-service to value-based models.
PBS News Hour
Some analysts interviewed by PBS predicts that more of the ACA will survive than many think. Some aspects of the law, they said, garnered bipartisan support — and the fact remains that millions more Americans now enjoy health insurance, which means any politically viable replacement would need to find a way to ensure that those constituents don’t lose coverage. The problems that gave rise to the health law in the first place, said PBS, haven’;t gone away: rising costs, an aging population and mediocre medical results. The payment reforms may also survive in some form.
Since Trump only highlighted ACA repeal during the final days of his campaign, and didn’t make it a central issue in his platform, Politico said this lack of emphasis may help Republicans downplay expectations if they can’t repeal the law quickly.
But a Trump administration could have a huge impact on the law even without Congress. The Health and Human Services secretary has significant discretion on decisions that shape whether the law can function as intended. A Republican administration could relax requirements on Medicaid, for example, or relax rules so states can set up alternatives to the ACA.