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A Trump presidency: Look for evolutionary, not revolutionary, changes in health care sector

January 31, 2017
David Lareau
From the January 2017 issue of HealthCare Business News magazine

By David Lareau

The long presidential race is finally over. The final outcome took many by surprise, including most of the media and pollsters, but Donald J. Trump is now the 45th president of the United States. For those of us in health care and health IT, we now get to figure out what a Trump presidency might mean for our industry. Before consulting the crystal ball, however, let’s first look back at some of the major legislation impacting health care over the last few years.

• The American Recovery and Reinvestment Act of 2009 (ARRA). ARRA freed up billions of dollars for health systems and physicians to invest in EHRs. To earn financial incentives and avoid penalties, providers went on EHR buying sprees and worked to become “meaningful” users. Many physicians in smaller practices opted to join larger practices or health systems to avoid the hassle of selecting and implementing an EHR. Meanwhile, a half-dozen vendors locked in big chunks of the HER market share.



• The Affordable Care Act (ACA) – aka Obamacare. This legislation addressed insurance reform, rather than health care reform, and did little to change the framework of how health care is delivered. The ACA requires employers with more than 50 employees to provide insurance coverage and pays financial subsidies to low-wage earners to help pay for coverage. We’ll likely see some changes to the ACA under a Trump presidency and a Republican-controlled Congress, such as giving states more power to control their own health care spending and deciding whether or not Medicaid should be expanded. A total repeal of the ACA is unlikely given that it’s enabled 20 million Americans to get insurance coverage. Elimination of coverage at this point might be a career-limiting move for many in Congress, including all those up for re-election in just two years (one-third of the Senate and all of the House).

• Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MACRA is designed to bend the cost curve so that providers are compensated for outcomes and quality of care, versus the number of transactions performed. This legislation is at little risk of repeal, especially since it was originally sponsored by Republicans, including House Speaker Paul Ryan. In addition, health care simply must become more efficient, given the aging of our population, the increased occurrence of chronic illness and the looming shortage of primary care providers.

In summary, while a Trump presidency will have some impact on health care, the changes won’t be cataclysmic. Health care costs will continue to rise, so we must continue seeking opportunities to control costs and improve care by incorporating evidence-based guidelines and gleaning new insights from big data and genomics. Furthermore, these tools must be made available where care is delivered – at the point of care – and available in a means that supports the ways doctors think and work.

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