Sweeping changes to legislature are occurring barely one month into Donald Trump’s presidency. On January 9, 2017, the Journal of the American College of Radiology released an article citing four main areas of healthcare that might be affected by Trump’s presidency: repealing of the Affordable Care Act (ACA), increasing executive branch authority over physicians’ practices and payments, eliminating the CMMI and its impact on The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, and changing tort reform.
Repealing the ACA
Since 2010, over 20 million individuals who previously had no or little access to healthcare have received it through the mandates of the Affordable Care Act. Even prior to its inception, some Republicans vowed to repeal or even abolish the ACA, which they can now more easily do with a GOP-packed House and Senate. However, Republicans have currently backed away from outright dismantling the ACA, and Trump claims his replacement program will be better. Some Republicans agree that they need to start by fixing the individual market and not touch Medicaid and Medicare.
Additionally, Trump has expressed interest in eliminating the Drug Supply Chain Security Act (DSCSA). While Trump might see the DSCSA as a good kind of regulation and choose to remain in accordance with the DQSA/DSCSA, a total repeal is unlikely since certain states could enact more imposing legislation.
Increasing Executive Authority over Practices and Payments
The Obama administration showed an increase in executive branch authority over physicians’ practices and payment methods, and this trend is expected to continue under Trump. The Center for Medicare and Medicaid Innovation (CMMI) is one such example, as it tries to improve costs and quality control as well as implement and monitor healthcare delivery system models and payments. Reductions to the ACA could result in downsizing or eliminating the CMMI.
Converting Medicaid to a block grant program could make states more responsible for paying larger portions of benefits, and this could possibly happen under Trump’s presidency. There is also the possibility that Medicare could become a voucher-based privatized system that would enable the government to only pay a fixed sum for every enrolled individual.
In 2015, MACRA passed in an attempt to stabilize fee schedules for physicians participating in Medicare. Medicare payments became based on the cost and quality of healthcare. While it seems unlikely that MACRA will be eliminated, its long-term impact could be reduced if the CMMI is shut down. The most problematic aspect of this is that medical practices have already spent time and resources trying to prepare to change over to MACRA, so any major changes could provide complications for practices.
Changing Tort Reform
Republicans have a long-standing history of supporting tort reform. Tort reforms tend to make it more difficult for people to file lawsuits, obtain a jury trial, or receive a significant amount of money from a personal injury lawsuit. There is some potential that malpractice reform could become a national, rather than state, issue.