As November 8th came to a close and electoral votes were being tallied across the country, the proverbial “shot heard around the world” was heard. Americans dissatisfied with the status quo and insider politics elected Donald J. Trump as the 45th president of the United States. IDC Health Insights reflects on the impact a Trump presidency will have on healthcare and healthcare IT initiatives.
It is too early to predict with any certainty what will happen to the U.S. healthcare system over the next four years and the timing of those changes, and consequently investments in healthcare IT as a number of different scenarios could unfold. But, we do know that a key tenet of Trump’s plan for “health reform to make America great again” is to repeal and replace the Affordable Care Act (ACA). This is something that the Republicans in Congress have wanted since the ACA was signed by President Obama in 2010. Should that promise come to fruition more than 20 million Americans could lose insurance coverage.
Details describing what might replace the ACA have been vague. The foundation of analysis is perhaps best found in Trump’s seven-point plan for health reform on his website (https://www.donaldjtrump.com/positions/healthcare-reform.):
Completely repeal the ACA
Allow sale of insurance across state lines
Allow individuals to deduct health insurance premiums from their tax returns under the current tax system
Allow individuals to use Health Savings Accounts (HSAs)
Require price transparency from healthcare organizations
Provide Medicaid block-grant to the states
Allow importation of “safe and dependable” drugs from overseas
Politically, it is useful to note that while a Trump presidency will have both houses of Congress controlled by Republicans and the next Supreme Court Justice will be nominated by Trump, he will not be able to act as fast as he promised on the campaign trail. He can overturn President Obama's Executive Orders, but other changes will require going through the complex budget reconciliation process, passing new legislation, or bringing new cases before the Supreme Court. In addition, a number of members of the Republican leadership distanced themselves from Trump over the course of his campaign. Progress in fence mending will create the first indicators of potential change in healthcare law and regulation.
It would also be difficult to repeal the entire ACA program as many of the principles behind ACA are now established in the U.S. healthcare system. Consumers also favor some aspects of the ACA such as coverage for pre-existing conditions and children up the age of 26. Healthcare organizations are now focused on achieving the Triple Aim of improved quality, value, and patient experience and value-based healthcare. Last year’s repeal bill passed by the Senate, but vetoed by President Obama, may provide insights into the changes one might expect to unfold over the next four years. These changes include eliminating the ACA’s subsidies for consumers to buy health insurance, Medicaid expansion, and the medical device and Cadillac taxes.
While it’s unclear what will replace the ACA if Trump is successful in repealing some or all of it, healthcare organizations’ priorities will assuredly change over the next four years to meet new Federal mandates. In the near term, we expect investment in healthcare IT will slow down until more is revealed about his plans for repealing and replacing the ACA. Using Trump’s seven-point plan as a starting point, IDC Health Insights Analysts will analyze the impact of a Trump presidency on healthcare organizations and how it will affect their investments in healthcare IT and services. Look for IDC Perspectives to be published shortly in the IDC Health Insights programs covering payer, provider, value-based healthcare, connected health, and life sciences.