Changes Coming to Healthcare System

Donald J. Trump was sworn in as the 45th President of the United States on Friday, a transition of power that promises to once again transform the nation’s healthcare system in a fashion as dramatic as the changes his predecessor, President Barack Obama, brought about eight years ago.

However, the form of Trump’s health reform will take is unknown. While repealing Obama’s signature Affordable Care Act was a main plank of Trump’s campaign, the new president has not revealed what will replace it or when.  Will he work with a Republican-controlled Congress to gut and replace the ACA concurrently? Will repeal be accompanied by a date certain for a future replacement? Will that future target be extended as was the case in repeated attempts to fix the Medicare Sustainable Growth Rate or “doc fix”? No one knows. President Trump on Friday did not mention healthcare in his inaugural address.

Last weekend in an interview with the Washington Post, President-elect Trump said of his new plan, “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”  He didn’t provide specific details.

Neither has Tom Price, the new president’s designee to head the U.S. Department of Health and Human Services, who on Wednesday had a confirmation hearing before the Senate’s Health, Education, Labor and Pensions Committee on which Massachusetts Senator Elizabeth Warren (D) serves.  Price said the new administration “would allow for every single person to gain access to the coverage that they want and have nobody fall through the cracks.” Under intense questioning, Price did not delve into details.

On Tuesday, the non-partisan Congressional Budget Office released a report saying that repealing the ACA without a replacement would result in 18 million people losing coverage in the first year, and 32 million by 2026. Premiums in the non-group market would also spike by 20 to 25% in the first year after repeal, the CBO wrote.  Republicans slammed the report saying its conclusions are based merely on full repeal without any consideration of a replacement strategy.

Democrats countered by saying how can one even begin the process of dismantling the ACA before even creating a replacement?  Massachusetts Rep. Richard Neal, the ranking Democrat on the Ways & Means Committee, said on the House floor last week during debate on a measure that began the process of dismantling the ACA, “We want to hear what the plan is, we want to understand what the alternative is, we want to know precisely what is going to be included — or just as importantly, what will be excluded — from the benefits that this Affordable Care Act has given to the American people.”

“Until the details are revealed, the only thing safe to say is: change is coming,” said MHA President & CEO Lynn Nicholas, FACHE. “But all indicators show that change will pose a threat to the collective healthcare reform successes that have been achieved in Massachusetts dating back to 2006. MHA is opposed to the repeal of the ACA and has committed to work with state and federal policymakers to ensure that affordable health coverage is sustained so that our efforts can continue to focus on the promising payment and delivery reforms that are underway.”