After Donald Trump’s victory over former Secretary of State Hillary Clinton on Tuesday night, many independent physicians may be wondering — what comes next? As the world prepares for Donald Trump to be inaugurated as our 45th President, we begin to consider some of the ways in which Trump’s policies could have an impact on the independent physician community.
Here, we offer a few predictions around how a Trump administration will address the biggest health care issues affecting independent physicians.
Prediction 1: Say Goodbye to the Affordable Care Act
Under president-elect Trump and with a Republican majority in both Houses of Congress, it is clear that Obamacare or the Affordable Care Act (ACA) will be repealed. What is less clear is how Congress and the Trump administration will do so, while continuing to ensure health insurance coverage for the estimated 20 million Americans who obtained health insurance through the ACA. This is a complicated challenge, and one that will involve collaboration between the public and private sectors.
Some ideas that the Trump administration may pursue were outlined by the candidate during his ‘Gettysburg Address’ where he detailed plans for the first 100 days of his campaign:
- Improving incentives for individuals to buy insurance by making premiums fully tax deductible.
- Emphasize Health Savings Accounts (HSAs) as tools for all Americans to save for health care costs, tax-free, and enable these to be passed down as part of an estate without penalty
- Increase competition within the insurance marketplace could also be introduced through removing restrictions on the sale of health insurance across state lines.
The last concept seems likely to get the full support of the Republican Congress, as this was also detailed in House Speaker Paul Ryan’s “Better Way” document released in June.
Prediction 2: MACRA Maintains Momentum
What will be much less talked about than repeal of the ACA, but arguably more relevant for physicians, is that a Trump administration is unlikely to substantively affect the transition of reimbursement models from fee-for-service to value-based. There some clues that say that the Trump administration may accelerate this trend. One of the 7 planks to his health care policy is block-grants for Medicaid that would invest states with more power in determining reimbursement policy. This is likely to take the form of policies that reinforce outcomes over fee-for-service as states will be developing new rules to distribute Medicaid funds.
It’s also important to keep in mind that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – Medicare reform – was passed in 2015 by the Republican majority in Congress which was not changed in the recent election. In fact, in a rare example of truly bipartisan support in 2015, MACRA passed with huge margins of 392-37 votes in the House, and 92-8 in the Senate. Trump’s campaign has continually emphasized a commitment to evaluating regulations once in power; yet it seems unlikely that such broadly supported legislation will be on the chopping block.
What this means is that physicians should continue to prepare their practices for the first year of MIPS reporting in 2017, or to pursue the APM path as an alternative.
Prediction 3: More Support for Independent Practices
This is the least confident of our predictions, but one that could be deduced from the overall messaging that the Trump campaign has advanced throughout the election season. As with any new shift in government, there is mostly uncertainty around how campaign rhetoric will translate to reality, and particularly so this year.
Hypothesis 1 – President-elect Trump will promote the ability of independent physicians to deliver high quality care, particularly in the rural areas where he has his most fervent support. Independent medical practitioners are small business owners who are essential to the fabric of the communities in the areas that voted for Trump, which resonates with his political philosophy. This could translate to a measured approach to implementing new policies that ease the impact on independents, such as the changes CMS made to introduce flexibility and additional options in the MACRA final rule.
Hypothesis 2 – The Trump administration looks to deregulate the business sector, putting more power into the hands of corporations. In health care, this could accelerate the ability of large hospital systems to acquire and consolidate the practices in their local areas without regulatory interference. Those conglomerates that put increasing pressure on independents to sell their practices and move to an employed model.
At Elation, we are on the record about our support for independent practices and their critical role in delivering high quality care and lowering overall cost of care for patients. We hope that the new administration will take an approach in line with the first hypothesis above, continuing to ensure that independent physician practices are empowered as reimbursement and regulatory models change. Elation plans to continue to support the push towards interoperability and a truly networked EHR, and to support our customers in maintaining their independent status and focus on their patients. Our commitment to defending the doctor-patient relationship is our number one priority, and we hope it becomes a priority for the Trump administration as well.