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President-elect Trump's Impact on Healthcare

President-elect Trump's Impact on Healthcare

Donald Trump has been elected the 45th president of the United States, and along with the Senate and House maintaining their Republican majorities, a tidal wave of healthcare policy changes could be just around the corner.

While specific details have yet to come out regarding health policy under President-elect Donald Trump, speculation has already begun on what could happen immediately. For one, the Affordable Care Act (ACA) could be in imminent danger. House Speaker, Rep. Paul Ryan, and Senate Majority Leader, Sen. Mitch McConnell, have already spoken about repealing the healthcare law in the early days of the Trump presidency.

In a press conference, McConnell said of repealing the ACA, "It is a pretty high item on the agenda. I would be shocked if we did not move forward to keep our commitment to the American people."

Along with a repeal of the ACA, here are a few other things that could happen to health policy under President-elect Trump in his first year in office.

*Medical Economics, a sister site of Physicians Practice, contributed to the reporting of this story.



Physicians Practice


While an overhaul of our medical insurance seems very appealing for all practices, If a replacement system created out of poorly educated, misinformed, and flawed data dictates its contents disaster awaits. If patients wind up with no insurance, physicians will watch an decreasing number of filled scheduled appointments.

laurie @

your point is valid, but medicaid expansion has been nothing short of a disaster. Most Physicians in my region are shutting their practices, working for urgent cares and Universities, most of the ones employed by the latter eventually get fired anyway, so we are back to square one. I don't see repealing Obamacare is insuring less people, I see it as stopping the mess that medicaid expansion has created.

felix @

The affordable care act is a start, towards getting best system for Unite states. Republican leadership now has an excellent opportunity, unfettered, to take it forward. Unfortunately they have spent no time thinking it through, and probably will try to do the least possible. The very best Republican idea is HSA's, but they have terrible flaws, one needs to make more than about 60,000 dollars to afford to put away enough money to take advantage of it.( average US income is about 45,000. Also it benefits the healthy, punishes the ill.
Great failure of Democrats is arguing about health care as a right, it is not. leaving the best arguments of all unsaid. Which include
1) taxpayers("goverenment") already pay for most of health care. Through medicare, medicaid, Tricare, VA , not to mention government workers, local govt workers and counting tax underwriting of so called commercial insurance since 1948.
2) Emtla, and like laws, make caring for unisured a burden, which cause insurance to be higher.
3) free market in health care is in operation throughout the world. So if you have money you can buy a car, if not, walk, if you can afford health care you can have it, otherwise die. i do not think we want that.
4) Providing health insurance is a terrible burden for businesses, small and large, if freed from this could only encourage business growth.
So: some type of universal coverage would be best, modified for this capitalist economy, eg plans administered, like medicare, through private means. Allowing better than average coverage for the wealthier, with after tax dollars( a really nice market for insurers.
Alternatively, provide medicare for catastrophic illness( cancer, trauma etc.) and leave the rest to the private market.
Truly there are so many great possibilities, unfortunately there are few if any in current regime who are interested in doing the work, which would be a lot, to make it happen.
Almost anyone i can think of, Don
Berwick, Tom Daschle and others tend to be democrat, unlikly to have a voice.

lennox @

While the goal of universal coverage is noble, the ACA was poorly thought out.
Nancy Pelosi was right- congress needed to pass the bill for us to find out what is in it. Well, we are now finding out. I have college grads in my practice who are earning $30,000/yr in their first jobs, and have $3,000 deductibles. I also have
"Pre-Medicare" couples in their early 60's
who saw their premiums double under our state's version of the ACA.

John D. @

MACRA Legislation is so far down the path - I doubt this administration will be able to thwart the momentum that is 6 years down the path - plan to demonstrate your outcomes...

Kim @

The ACA requires insurance to cover ALL kinds of medical coverage for everyone. IE the plan has to include all the things outline in the ACA. For example Stone therapy, Chiropractic etc. If people use those things they should get the option of adding it to the base line coverage. If they don't then they should be able to acquire a plan that covers what they NEED. If that were the case then the majority of the plans would be far more affordable. As an employee of a hospital I find the ACA has been a tremendous detriment to All forms of health care. The requirement of payment to the hospital reimbursement based on patient satisfaction scores really has no bearing on the care they received. Drug seeking patients and patients who do not hear what they wished for or non compliant patients drive the reimbursement of a hospital. the ACA has added a huge layer to hospital cost in requiring Electronic Medical records. I get the use of technology. How many of the elderly have a computer and use it. I am in my 50's and do not find technology easy for me. Granted there are computer savvy 90 year olds out there. Using and requiring electronic patient portals and medical records for physicians and hospitals to be electronic or incur a fine is ridiculous. There is no clear format for the information so now we have so many different versions of electronic records out there that many records are not able to be transferred to another system. For example, if you are transferred to another hospital or you choose to see a specialist all that information in one system is not available to the other. It is a worthless requirement until there is an ability to link each record system to another in ALL cases.

Janet @

Here is what will happen: the insurance and drug companies will do fine. the doctors and patients will get screwed ... as usual.

k @

The bill passed last year and vetoed by president Obama, apparently had a 2 year implementation time. Thus people would still be able to use the marketplaces as they are now for that time period.
in 2 years there will be an election where the entire House and part of the Senate is up for re-election. So if the 20 million people who stand to lose their insurance vote against the incumbents who voted to repeal ACA provisions, then there might be a different Congress in 2 years, and a different president in 4 years.

estelle @

Everyone wants to get rid of pre-existing conditions except the insurance companies. However, if the Republicans pass a ban on pre-existing conditions as a stand alone law, the insurance companies will simply stop providing health insurance.
There were several reasons ACA was so complicated.
1. Votes for the plan were negotiated by giving representatives certain features that benefited their states.
2. insurance companies demanded certain features else they said it would not be financially feasible for them to participate. That is why there are gov subsidies to plans and mandates about coverage.
3. Pharmaceutical companies demanded certain features
(both insurance companies and phar companies provide lots of money to representatives so they can get reelected).

remember: competing marketplace was a Republican idea going all the way back to Nixon.

also, we already see plans originating in other states. Crossing state lines just allows people to buy worse plans from less regulated states and takes away state rights to regulate ins companies in their own states.

finally, ins premiums have been going up annually for people with individual plans. I was on the same plan for 10 years and my premium costs went up 20-35% every single year because i had a condition and couldnt switch plans. i spent $2500 in 2003 and $29,000 in 2014 for my premiums.

estelle @

Healthcare must be ACCESSABLE and AFFORDABLE. There is still a huge gap if providers are not accepting ACA plans for various reaons. Keeping your own doc: in our area, people in our service area 5-10 miles away are not allowed to 'cross the bridge' for their care and have had to try and seek other PCP's. Almot no one in our area (rural Maine) are accepting new patients. Insuarnce companies and pharma companies MUST be regulated--in SPITE of lobbyists! Hospitals MUST reduce the incredible waste in their systems. Stop trying to squeeze more out of the primary care physicians who should be at the TOP of this healthcare chain, not struggling for meager recognition at the bottom!

Elizabeth @

The biggest problem in healthcare is that no one has control over the insurance companies - what they charge the consumer, what they pay the physician, or what they pay their CEOs in big bonuses each year. The patient ultimately pays the price. Someone needs to make sure that the insurance companies are looking out for both the patients and the doctors. I am a nurse and have watched for many, many years the cost to the consumer go up and the payments to doctors go down. THE ONLY ONES PROFITTING ARE THE INSURANCE COMPANIES. This is why they put money into our politicians' pockets to look the other way. The problems will never resolve until someone takes control of the insurance companies and makes them do right by their consumers. Doctors and Hospitals raise their prices so they can stay afloat paying their employees, keeping up on new technology to treat their patients, paying their overhead, while receiving less and less in their reimbursements from insurance companies. Its time the American people stand up and question the insurance companies and ask how their CEOs receive millions or more in bonuses each year when we have people who cannot afford insurance just so they can feed their families on a daily basis.

Mary Jo @

Excellent comment Mary Jo!
They punish physicians for getting a pen or a notebook from a pharmaceutical company however no one says anything about the millions of dollars given to dirty politicians to keep them silent! It is a huge mafia!!!

D @

This is so very true! I work in the oncology field and insurance carriers are making the decisions as to what they think is really medically necessary for these patients! They are taking that decision away from the doctors. They deny claims to delay payments to providers. They penalize you for everything and change their guidelines as they see fit but dont notify providers. They refuse to pay providers when we submit late or do an appeal past the time, etc, but they can decide to audit claims from 3 or 4 years ago and say they processed wrong and that we must pay them back immediately. The carriers are paying less and less for claims and requiring more and more work from the providers.

Cynthia @

Amen! And let's not leave out the big pharm!

Deborah @

Amen! And let's not leave out the big pharm!

Deborah @

I personally think the idea of healthcare for everyone is a great idea. However, this system has been a disaster from the beginning. Forcing people to purchase insurance and these folks still have to pay out of pocket to meet a $5000 or more deductible is absurd. But, they purchased what they could afford. And, these plans still costs the average person a LOT of money each month. Also, for a President to come out and say you can keep your doctor was just as outrageous. That proves that he nor anyone around him realized that doctor/providers are in charge of their own insurance contracts. The 90 day grace period is laughable from the provider standpoint. So, a person pays a one month premium, can visit the doctor an unlimited amount of times for each month for 3 months and never, ever have to pay the 2nd and 3rd month premium. Guess who absorbs that outstanding debt....the provider. This needs to be removed from the plan immediately. Our office will not schedule appointments for anyone that upon insurance verification indicates a premium problem. Once we can verify they do in fact have active coverage with payment of premiums we will schedule them. This is why so many offices do not accept the ACA plans.

Cathy @

Exactly Cathy! And very few people know about this clause. Even most physicians do not know about this. And the burden falls to us to verify all of this just to receive cut reimbursement.

Deborah @

People that are responding here do not have enough "inside" knowledge on how the healthcare system works. "Yes" if you have mandatory coverage, insurances raise the premiums and employers will pass a lot of that cost on to the employee as well. Although insurances have lessened the deductibles, they also lower the amount they will pay and that is still passed on to the insured. The pre-existing conditions are the big issues as well because that is up to the insured to prove it isn't/wasn't pre-existing and that is hard to do when you haven't been able to afford to go to the MD. As far as being able to get in to a provider, that is because regardless, the MD's have to agree to contract with that plan and VERY few MD's are contracted with the ACA plans, unfortunately. Also, if ACA is repealed there are still filibusters in congress and I hope that someone will speak up. I have a job that provides insurance and I have had 2 medical emergencies that have almost made it impossible NOT to claim bankruptcy and/or lose my home. I can REALLY empathize with those less fortunate that cannot afford insurance and therefore let health conditions exacerbate due to finances.

DeeLonna @

People think that repeal of Affordable Care is going to be better for people, but what about the hospitals that bear the burden of the unpaid ER bills? What about those who cannot get insurance because of pre-existing conditions? I bore the brunt of an increase in my premium for a family of 5 to the tune of 500 dollars monthly. I have an employee that had to drop coverage for her husband because they could not afford to insure both. I guess they should just go and kill themselves.

Helene @

My premium before the ACA was $1200/mo for a family plan. If the ACA stands, as of July 1, 2017, my premiums for a similar plan will skyrocket to $2770/mo. an increase of 230%. I wish mine went up only $500/month!!

At the present, the ACA mandates via MACRA/MIPPS and its onerous HIPAA mandates are forcing solo and small practices like mine to consider or actually retire early and abandon our patients. Way to go ACA!!

Wesley @

There are ways that we can fix this and avoid the "pre existing" conditions. But it already on its way back to the way it was. The "big pot" of federal money is gone and carriers are just raising their rates again. It doesnt matter what type of plan that you have. Group or private. It is going back to them being to costly to afford and cheaper for people to be self pay and take the penalty at the end of the year on their taxes. Where I am, in 2017, 3 carriers are pulling their individual plans! This is in part due to over usage by patients that didnt have healthcare before and now got these super low cost, to free plans. Dont get me wrong, it is great that people can get the coverage, but they are limited on what they will actually cover. They will pay office visits, but most treatments are denied as not medically necessary or just not covered under the policy. If the patient really needs it they will have to pay out of pocket. The state health plans are inundated with newly qualified people that they cant find a provider. Alot of providers are closed to these policies because they dont pay. They pay less than Medicare rates. Medicare will have more fines and fees in the new year, that their reimbursement is going down. This in turn will cause the state plans to go down in payment. It is a big mess. If you were one of those people over 65 and chose a Medicare advantage instead of just Medicare because you cant afford a secondary or the indefinite 20% co-insurance, and you get cancer or some other horrible illness, you cannot revert back to the lesser option of Medicare because no Medicare supplement will take you. So the pre existing condition still exists in these carriers.

Cynthia @

All those calling for the repeal of ACA should recall what it was like when patients were denied insurance due to pre-existing conditions. Providing affordable insurance to those patients without also having an individual mandate is impossible. It is akin to allowing people to drive without car insurance and then asking car insurance companies to sell insurance to someone AFTER they have had an accident so that they can get their car fixed.

Vince @

Shades of gray people...providing "affordable" insurance WITH the mandate failed. It is no longer affordable that is why it is up for repeal and REPLACE. Not just repeal. It didn't work. So now we need to help come up with a way that does work. Ultimately people have to accept some responsibility for their own health. We cannot legislate people into caring. What we can do is provide affordable options that will not have pre-existing barriers for people who can show no lapse of coverage or can show poverty during that time frame. There are solutions...we just need to keep trying until we get it right.

Deborah @

Deborah, you are correct. The ACA is a massive mistake that is unaffordable.

Wesley @

Finally the disaster of Obamacare will come to an end! Maybe now we will get some common sense health care that people can actually afford.

ann @

Finally the disaster of Obamacare will come to an end! Maybe now we will get some common sense health care that people can actually afford.

ann @

Not to mention access.

Shari @

I think you are speaking of access to providers and unfortunately if MD's do not contract with the ACA plans, you cannot go see them. This is "why" it is hard to find MD's that contract with these plans. It was difficult to find specialty providers for people with low income insurance plans in the 1st place. There needs to be an incentive to providers that will contract with these plans so they will open up there patient panels to see these patients. Unfortunately, the reimbursement on some of these plans may be a lot less so MD's are unwilling, due to low reimbursement.

DeeLonna @

Why don't we have a conservative think tank come up with a plan based on private insurers providing coverage, test it out in a state with a republican governor and then try to implement it nationally.

Lawrence @

I think as long as we have for-profit insurance companies involved the profit motive will encourage insurers not to cover the poor or the sick. The most rational solution is a single-payer system that will truly be able to provide coverage to everyone by spreading the cost over everyone.

Terence @

Agree. Just go single payer and get it over with.

Daniel @

I would agree with you, except we're dealing with a situation where private monetary interests supersede the well-being of the nation's people. The bottom line is that the ACA struggled in part because of political pandering to lobbyists and those interested in a ballooning bonus to exorbitant salaries. The ACA was going to struggle because certain groups that didn't want it preferred to remove the effective parts of it while failing to add what was needed to get it to succeed. That's like breaking a soccer player's leg and then throwing the athlete onto the field. Ridiculous. It's evident. . .if you have a problem with the current, you find and implement a suitable alternative. when, over the past years, has there been discussion about REPAIR or REPLACE? No, only REPEAL. That says it all. There is no focus on the CARE of the American people. Making America Great Again starts with making their people healthy and wise, i.e. educated. Seems we're falling behind on both counts.


I agree and so do most Americans. Poll after poll shows that Americans want Medicare for All. Health care is a public good, not a commercial one. Understanding that basic economic difference between a public and a commercial good is key in reducing the cost (aka high profits to pharma and insurance CEOs and share holders) of health care.

Leann @

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