By Terrence L. Bauer, CEO, Specialdocs Consultants, LLC
Healthcare, in a constant state of flux for well over a decade, is entering yet another new era when the Trump administration takes the reins in January. While it may appear as if change is the only constant, we are gratified to see a great deal of positives ahead, especially for independent physicians. At our most recent Specialdocs webinar, experts from leading healthcare advisory and research firm, The Marwood Group, explored the potential impact of this historic election on healthcare legislation. Marwood’s main political strategist Michael Gaffin, and Joseph Mercer, group vice president who tracks federal legislative and regulatory policies, offered these important perspectives:
- Fate of the Affordable Care Act (ACA). Congressional Republicans will move to repeal the ACA as soon as possible. While there is no solid replacement plan for the short term, and it will likely be a two to three year transition process, there are certain aspects we can plan on. Subsidies may be replaced by tax credits across the board, as outlined in the Paul Ryan plan. This can serve as a potential advantage for concierge or primary care models if sufficient numbers of people who didn’t purchase insurance before do so now because of a tax credit of up to $2500. Continuous coverage may replace the individual mandate; patients who have received coverage for a condition without a significant gap should be protected from pre-existing condition exclusions.
- HSAs and FSAs can serve as an even more prominent centerpiece for real change if appropriate legislation is advanced. Their value proposition is a sound one, as a consumer choice model encouraging better access to primary care through use of pre-tax or savings dollars. This will ultimately lower overall healthcare costs by encouraging a focus on preventive care. These benefits will be used to spark a dialogue on both sides of the political aisle. The use of HSAs and FSAs presents a significant advantage for independent physicians to position themselves well, and offer patients the opportunity to allocate these dollars for personalized care membership fees and other healthcare services that they may designate.
- Insurer exodus from the exchanges has been problematic and may accelerate if changes to the ACA are not implemented. Sale of insurance across state lines is expected to be part of any future plan, but we are not certain that it will have as significant an impact on costs as was promised on the stump.
- Items unlikely to change:
- Medicare: support for premiums has been a political non-starter in the past – any modifications will be slow to occur, possibly four to five years down the road.
- The possibility of passage for the public option is non-existent now as it couldn’t happen even with a Democratic congress. This may be several political cycles away if ever.
- Another government-sponsored payor option is also highly unlikely as problems with access and reimbursement would continue to pose difficulties for physicians and hospitals.
- MACRA will move forward, as it passed with broad bipartisan support, suggesting that the emphasis on quality and value initiatives will continue to be a major focus in a Trump administration. The pushback on implementation deadlines could be recognized, and additional flexibility and a slower rollout for physicians may result.
- The future of Accountable Care Organizations (ACOs) are a bit trickier to predict; overall there is a general endorsement of cost-lowering initiatives, but it’s hard to foresee the level of support for ACOs in the new administration.
One point we can agree on: a choppy period looks to be ahead as our healthcare system continues to evolve. We are very optimistic with the recent choice of Rep. Tom Price for Secretary of Health and Human Services and we are hopeful that he will be able to drive his four central healthcare reforms forward as outlined in the Wall Street Journal Opinion on December 1: providing a path to catastrophic health insurance for all Americans, accommodating people with pre-existing health conditions, allowing broad access to health savings accounts and deregulating the market for medical services.
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We’ll continue to monitor developments and share news that directly impacts independent physicians, especially those practicing or considering a change to concierge medicine, the model we believe holds the key to better care, lower costs, improved outcomes and more engaged physicians.
NOTE: This is intended as a summary of the webinar held with The Marwood Group in November, with some additional editorial from Terry Bauer, Specialdocs Consultants.