Central PA Medicine - February 2017 - 29

daup h i n c m s  .o
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s of 2015, the United States spent
about $3.2 trillion on healthcare,
making it the 5th largest economy
in the world, behind only the American, Chinese, Japanese and German national
economies. Few would deny that this finding
entails degrees of high quality and accessibility
in healthcare compared to other countries,
combined with a tremendous amount of waste in
costs and in health priorities. As such, healthcare
delivery was a major feature of discussion in the
recent Presidential campaign, and will make
frequent headlines in the future.

Analysts have made many predictions of what
will happen over the next four years. By the time
you read this, the ever-changing daily news may
make some of them come to fruition or not.
During the campaign, Mr. Trump made vows
to repeal the Affordable Care Act on day one
of his term. As time went on, and, following a
post-election meeting with President Obama, he
has softened his stance, and will more likely get
Congress to repeal parts of it and to keep others.

What else might change
under President Trump? 

Look for expansions of tax credits
and/or deductions for medical care.

lines, under Federal standards. This accessibility,
like that of other forms of insurance, will likely
lower costs through competition. It is certainly
sensible, as modern technology has made the
need for an insurer to be physically near its
participating hospitals and providers outmoded.
A problem with this proposal, for consumers,
is that insurers will likely base their operations
in states with the most lax regulations, causing
a problem for out-of-state insured customers
with coverage dilemmas.

President Mike Pence approved the Medicaid
expansion while Governor of Indiana.

What else might change under President
Trump?  Look for expansions of tax credits
and/or deductions for medical care. Incentives
for Health Savings Accounts might increase,
making them both portable from year to year,
and even transferrable in estates. To limit waste,
there has been bipartisan support for price
transparency from healthcare providers. Other
issues will likely not change. Trump will likely
Democratic leaders have warned that repealing not greatly restrict the pharmaceutical industry,
the ACA would stick states with billions of in line with his vows of job protectionism. Also
What will likely be kept untouched?  For dollars in costs for newly uninsured patients, despite his personal reversal in viewpoints about
starters, the prohibition of rejection of private estimated to be $69 billion over ten years. abortion, he will likely not strongly push for
insurance coverage due to pre-existing conditions However, support for rollbacks could likely be overturning Roe vs. Wade. This issue remains
will likely stay. Second, the ability to continue bipartisan, as evidenced by Hillary Clinton's in the jurisdiction of the Supreme Court, and
coverage for dependent children up to the age avowals of modifications. If any benefits are a Trump Administration push for this would
of 26 if necessary will also not be touched. Lastly, rejected, it's likely that Congress would allow act as a linchpin for further Congressional
the provisions that have led to the procurement a long turnaround period, to prevent patients bureaucratic gridlock by partisanship. Lastly,
of health insurance by an additional 22 million from abruptly losing coverage. While the ACA bans on lifetime insurance coverage for specific
Americans since 2010, via a combination of has worked out fiscally in some large states like disease states will likely continue.
subsidized private insurance exchanges and California, it has not done so in some smaller
expanded Medicaid coverage, will not be fully and mid-sized states. Insurers have pulled out
President Obama presented an eloquent
dismantled. Repeal of these items could be of money-losing state exchanges, leading to and comprehensive support for the Affordable
politically suicidal for President Trump and the higher premiums and deductions that Care Act in the August 2nd, 2016 issue of the
the Republican-led Congress.
have garnered criticism of the law. It has been Journal of the American Medical Association.
prognosticated that, within the next few years, Non-withstanding, criticism of the law has
Despite this apparent softening of his inten- up to one third of Obamacare enrollees might been bipartisan, and changes are likely on the
tions, Trump selected Rep. Tom Price (R-GA) have only one insurer option per state.
horizon, although full repeal and replacement
as his new Secretary of Health and Human
is far-fetched. Budget-related legislated changes
Services. The former orthopedic surgeon has
 Regarding Medicaid coverage, Trump has need a simple majority, so bicameral Republican
voiced his opposition to the ACA. As current stated opposition to the current federal-state control will ensure some law alterations. On the
chair of the House Budget Committee, his financial system, as it incentivizes state politicians other hand an ACA replacement bill would
interest and influence in doing so will make to maximize the Federal share of funding, while need support of 60% (which is greater than
him a formidable foe of Democratic legislators burdening the states with oversight measures current Republican rolls in both the Senate and
who support President Obama's pleas to keep from Washington. A proposal by Trump and the House) of the Senate to prevent a filibuster,
the law as is. One change he supports, along Ryan would replace this with block grants, so repeal is unlikely.
with House Speaker Paul Ryan and Senate putting more onus on the individual states
Majority Leader Mitch McConnell, is to allow to control costs and administer the programs.
private insurers to sell their products across state Large cutbacks are not likely; even new Vice
Central PA Medicine February 2017 29


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