Throughout Donald Trump's campaign, the president-elect vowed to change America's healthcare by repealing and replacing the ACA and favoring a free-market approach over increased government oversight.
His proposals — like repealing the ACA, expanding health savings accounts, reestablishing high-risk insurance pools and allowing states to administer Medicaid through block grants, among other policies — may now come to fruition. Panelists at the Becker's Hospital Review 5th Annual CEO + CFO Roundtable on Nov. 9 discussed the implications of such policies on the healthcare industry.
Here are four ways healthcare leaders think the election will affect healthcare and the ACA.
1. Uncertainty over the ACA's repeal and replacement timeline. "There will be this repeal and replace movement [of the ACA], and a lot of the replace will include the current. But what's the real politics of this and how long do you think this will take?" Joseph Lupica, chairman of Newpoint Healthcare Advisors, asked panelists.
Steve Rice, area president of physician services at Integrated Healthcare Strategies, says once the outcome of the election begins to set in, President-elect Trump will need to shift gears from lobbying for an election to running the country. However, Mr. Rice says it is unclear how quickly that will happen.
"Coming out hard and saying I'm just going to rip off the Band-Aid as fast as I possibly can … in my opinion, I don't think that's going to happen," Mr. Rice says. "It'll have to be more thoughtful. I know that's counter to the way Donald Trump talks, but hopefully what will happen is the team he puts together will allow him to function in a way that if there is repeal, if there is replace, there's some rigor underneath [those words]."
However, John Cacciamani, CEO of Philadelphia-based Chestnut Hill Hospital, says he thinks the process may be "faster than you think in terms of timeline. [Republicans are] going to see that they got two years to make sure they can get this deal done."
2. Decisions about what will remain of the ACA. A concern for the poor and uninsured needs to be sustained by the president-elect, Lyman Sornberger, chief healthcare strategy officer at Capio Partners, says.
"He's going to try to commit that he's for the underinsured in some way, shape or form. To abort that too quickly or abolish it would be a career suicide," Mr. Sornberger says. "I think he'll create a more competitive market, which I think Hillary was trying to move toward with ACA evolution."
Another element the Trump administration may maintain is the value-based care momentum carried by the ACA, says Alison Tothy, MD, chief experience and engagement officer and associate professor of pediatrics at the University of Chicago Medicine. Dr. Tothy says she hopes "that patient-centered care and the intersection of quality, safety and experience really won't disappear from the true meaning of how we design healthcare in the future."
3. Decisions about what will be eliminated from the ACA. Mr. Cacciamani says that when one looks at the progress made over the past eight years, the value equation has not moved much under the ACA. While he agrees support for the poor and uninsured through Medicaid should be kept, he thinks a lot of the bill's aspects will not be maintained.
"Everything from EHR economic support to ACOs — we haven't made much progress as a country," he says. "I think there's a lot that's going to be taken away. I think it's going to be shelled for the most part."
4. Development of new options. In terms of possible new paths from the ACA, Mr. Cacciamani says he thinks the incoming administration is going to look at a voucher system and operate to make sure as many Americans as possible have health insurance while avoiding constricting regulatory oversight.
Mr. Sornberger says if Mr. Trump can extend an olive branch to House Speaker Paul Ryan (R-Wis.), he could evolve Mr. Ryan's already constructed plan. Mr. Rice added if a new plan emerges, it will need the full support of payers to succeed — a piece that has fallen short under the ACA.