President Trump has been clear in his intention to repeal the ACA. In fact, among President Trump’s first executive orders was one seeking to “minimize the economic burden” associated with the Patient Protection and Affordable Care Act (ACA). In addition to calling for its prompt repeal, he calls upon the executive branch to minimize the regulatory burdens of the ACA and provide the States with more flexibility to “create a more free and open healthcare market.” So what might that mean for hospitals? Shortly after the election, the American Hospital Association (AHA) sent a four page letter to then President-Elect Donald Trump advising him of its own public policy priorities and their vision for healthcare reform. (See prior blog post here). How will these AHA priorities fare during a Trump administration?
Reducing regulatory burdens. President Trump will likely consider regulatory reform that removes burdens to healthcare providers. Among these possibilities are: (i) the cancellation of stage 3 of the meaningful use program that would require costly upgrades of EHR; (ii) reworking the quality reporting requirements that are overlapping, conflicting and, in some cases, fail to focus on actual opportunities to improve care; and (iii) streamlining and coordinating the Anti-Kickback Statute and the Stark Law to protect clinical integration arrangements that promote enhanced and efficient healthcare.
Enhancing healthcare affordability and value. In its letter, the AHA explained that increased spending on hospital care is primarily attributable to pressures on hospital reimbursement and increasing hospital expenses that are outside hospitals’ control and that should be controlled in other manners. Specifically, the AHA seeks, among other things: (i) solutions to escalating drug prices; (ii) challenges to major health insurance company mergers; and (iii) malpractice reform. President Trump, in many comments during the campaign and since his election, has emphasized the need to combat rising drug prices. In light of President Trump’s stated desire to force insurance companies to compete with each other, it is likely that he will support President Obama’s prior efforts in this regard. With respect to malpractice reform, the “powers that be” in the Trump administration, as well as House Speaker Paul Ryan, support malpractice reform. President Trump’s pick to serve as the Secretary of the Department of Health and Human Services, Representative Tom Price of Georgia is a surgeon who has been outspoken about changes he believes are necessary to rein in healthcare costs that he attributes to a broken malpractice litigation system.
Of paramount concern to hospitals is the loss of coverage to the 20 million people covered by the ACA. Accordingly, in its letter, the AHA appealed to then-President Elect Trump to couple any repeal of portions of the ACA with the simultaneous implementation of a replacement plan to provide affordable coverage for individuals. While President Trump has urged a simultaneous repeal and replacement, the absence of any details on a plan to replace the ACA while he has already taken steps to ease its repeal will likely lead to a less than smooth transition to a new plan.