Here are four ways President-elect Donald Trump's proposed healthcare reforms could affect the hospital revenue cycle.
1. Tax-free, inheritable health savings accounts. Mr. Trump said he would sign legislation to promote tax-advantaged HSAs to encourage consumers with high-deductible health plans to set aside money for out-of-pocket healthcare costs. Mr. Trump would also tie HSAs to a person's estate, meaning an account could pass on to next of kin without facing federal taxes.
Some healthcare professionals believe HSAs will help increase price transparency and reduce healthcare spending, similar to theories around high-deductible health plans. Because consumers are using their own savings to finance their out-of-pocket healthcare services, some experts believe consumers will be encouraged to compare prices for the best deal and put pressure on hospitals to keep prices competitive.
Still, recent studies suggest HDHPs and HSAs reduce healthcare spending by causing consumers to avoid medical care altogether, not by encouraging them to price shop. Tax-advantaged HSAs would likely prove as ineffective as HDHPs at improving price transparency, but their tax-free status may help consumers save for medical payments.
2. Federal mandate for provider price transparency. Mr. Trump said he would require "all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals," to disclose service prices to consumers prior to treatment. This could speed the rate of price transparency adoption at hospitals across the nation.
3. New Medicaid funding method. Mr. Trump proposed dismantling financing for Medicaid expansion under the ACA and converting the program to a block grant to contain healthcare costs. Block grants would give states more authority over their Medicaid programs in exchange for accepting a fixed amount of funding from the federal government. This means states would not be required to cover certain groups of people, such as children, pregnant women and the elderly, to receive federal money.
Turning Medicaid into a block grant means "you have no guarantee that people who are now covered will continue to be covered, or whether [the states] will simply cut back on their Medicaid program," Rep. Henry Waxman, D-Calif., told Kaiser Health News. This could reduce the number of Medicaid benefits or number of Americans covered by the program, driving up uncompensated care rates at hospitals in impoverished or rural communities.
4. Repeal of the ACA. Mr. Trump vowed to repeal the ACA as one of his first presidential acts. Bill HR 3762, introduced into Congress October 2015, would: repeal ACA tax credits, end Medicaid expansion, repeal major taxes used to fund insurance expansion and create a two year transition period to dismantle ACA infrastructure. The Congressional Budget Office estimated 22 million people would lose insurance if HR 3762 is signed into law without a Republican replacement plan. The rise in uninsured Americans could negatively affect healthcare providers by increasing their uncompensated care and bad debt rates to pre-ACA levels.