Linda Rouse O’Neill
By Linda Rouse O’Neill, Vice President, Government Affairs
President Donald Trump campaigned on a promise to repeal the Affordable Care Act (ACA), and Congress has begun the complicated legislative process to deliver on that promise. In addition to repealing the ACA, President Trump and many Republicans in Congress are interested in additional changes to the U.S. healthcare system. These proposals include giving states a greater role in Medicaid and giving consumers more responsibility in saving for healthcare. While both the president and congressional GOP leaders have offered broad outlines about their plans, many questions remain about what legislative action will actually follow, how the transition will go, and the impact on the industry.
Here are some of the key healthcare issues to watch under the next presidential administration.
ACA in transition
While many in Congress are already focused on ensuring there are no major disruptions to the health insurance marketplace, some policymakers have suggested an effective date for full repeal of the ACA may not come for several more years. Even if the ACA is repealed, several recently implemented policies are expected to remain in place. These include value-based purchasing, reimbursements based on readmissions and hospital-acquired conditions, and authority for accountable care organizations.
Health Savings Accounts
Both President Trump and Republican legislators support expanding the use of Health Savings Accounts (HSAs). We expect several initiatives to boost the eligibility and incentivize HSA use, including allowing anyone to open and contribute to an HSA regardless of their type of insurance coverage, enabling spouses to make catch-up contributions to the same HSA account, and allowing individuals eligible for TRICARE coverage to contribute to HSAs.
Medicaid reform
One of President Trump’s campaign promises was to reform Medicaid into a block-grant program, where states would receive a certain amount of money (based on poverty levels) to manage their program with a degree of freedom. Republican governors have supported this idea, maintaining it will control costs. Republican majorities in Congress create a new opportunity to pursue this reform.
Price transparency
President Trump will likely seek improved price transparency across all providers, including clinics and hospitals. This measure has the potential to generate conflict between the White House and Congress, as insurers, pharmaceutical companies, physicians, and provider organizations may lobby against transparency efforts.
Nominees provide insights for potential Trump policies
President Trump’s selection of former Rep. Tom Price (R-GA) to head the Department of Health and Human Services and Seema Verma to head the Centers for Medicare and Medicaid Services offers some insights into the policies the administration will pursue. Both are believed to favor free market and consumer-directed solutions to healthcare challenges.
While Rep. Price has been a longstanding opponent of the ACA, he has also been a key ally for the healthcare distribution industry. Notably, he has advocated on behalf of industry stakeholders for replacing Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.
Verma is formerly President and CEO of a national health policy consulting company. She is considered the architect of Indiana’s Medicaid program, the Healthy Indiana Plan, and has also developed Medicaid reform programs, including waivers for Iowa, Kentucky, and Ohio. She has also helped implement HSA policies and healthy lifestyle requirements for Medicaid beneficiaries.
With these proposals and nominees, Congress and the White House will likely pursue a more market-oriented healthcare agenda. Though Republicans hold a majority in both houses of Congress, some of their proposals will be vulnerable to Democratic filibusters in the Senate. Republicans may be able to advance some initiatives through budget reconciliation and by collaborating with Democrats who face competitive races in 2018.
HIDA will continue to monitor the Trump administration’s health reform efforts throughout the year. Contact us at HIDAGovAffairs@HIDA.org if you have any questions, or want more information.