Now that Donald Trump is poised to become the United States of America’s 45th President, there are some broad and overarching changes coming to our country.
Many of the policies that President Obama worked so hard to accomplish in his tenure may soon be stripped down or even repealed by a Republican Congress and President, none bigger than the Affordable Care Act, commonly referred to as “Obamacare.”
In fact, the healthcare industry as a whole is potentially in for a huge shakeup. Here are seven things that President-Elect Trump “potentially” has planned for healthcare:
1. Plans to “Repeal and Replace” The Affordable Care Act (“Obamacare”) (Source)
FILE – In this March 23, 2010, file photo, participants applaud in the East Room of the White House in Washington, Tuesday, March 23, 2010, as President Barack Obama, flanked by Macelas Owens of Seattle, left, and Rep. John Dingell, D-Mich., right, signs the health care bill…
Throughout his campaign, Trump has promised to “repeal and replace” Obamacare if elected to office. Now that it has happened, it remains to be seen if President-Elect Trump will follow through with his claim.
According to analysts, a repeal of Obamacare would leave approximately 20 million people without health insurance. It would end coverage for those with pre-existing health conditions, as well as terminate provisions such as free birth control and coverage of young adults on their parents’ plans through the age of 26.
However, most experts don’t believe that President-Elect Trump can repeal the entirety of Obamacare. The Affordable Care Act was a huge endeavor, six years in the making, and it has had a broad impact throughout the healthcare industry. Just repealing and not replacing it would be political suicide as it would essentially leave 20 million newly insured Americans without a backup plan.
So what exactly does Trump have in store for Obamacare?
According to a report by NPR, “During his campaign, Trump proposed a series of measures that he said will allow people to buy affordable health insurance policies outside of the Obamacare exchanges. Those measures include promoting tax-free health savings accounts that might help individuals save money to pay for health care costs and allowing people to deduct the cost of their premiums on their personal income tax returns… Alternatively, Trump could embrace the health care plan promoted by House Speaker Paul Ryan, which starts with repealing the Affordable Care Act. It includes many of the same principles as Trump’s plan, but has more details…”
A study by the Commonwealth Fund shows that Trump’s proposed plan would leave as many as 25 million people, mostly low-income and those with pre-existing health conditions, without health insurance; and would increase the federal budget by $41 billion due to tax breaks given to people in order to encourage them to buy insurance, while not mandating them to (a requirement in the Affordable Care Act).
While all of this is eye-opening, we still don’t know for sure what President-Elect Trump will do. We do know that millions of Americans could potentially lose access to health insurance, and popular provisions within Obamacare could be at risk.
Cynthia Cox, an associate director at the Kaiser Family Foundation, had the following to say about a potential overhaul of Obamacare by the Republicans, “A Republican plan could preserve some of those aspects. But subsidies for plans offered through the ACA exchanges and Medicaid expansion would appear to be the first to go, possibly through the budget reconciliation process…”
Important to Note – “Passing a bill to overturn Obamacare would require 60 votes in the Senate, and Republicans don’t control enough seats to squash a filibuster by the Democrats. But GOP lawmakers, who will have 51 seats in the Senate, could use the budget reconciliation process that only needs approval of a simple majority. This process is limited to provisions that affect federal revenues and spending.” (Source)
2. Allow Health Insurers to Compete Across State Lines (Source)
In response to his claim to repeal Obamacare, Trump outlined his plan to allow for health insurers to compete across state lines. He expects this to keep healthcare costs down and still provide for those Americans with pre-existing health conditions.
However, many feel that this would actually have the opposite effect.
Larry Levitt, a senior vice president at the Kaiser Family Foundation, said as much, “Any attempt to increase consumer protections in a state could be thwarted by an insurer operating out of another, minimally regulated state, then selling that plan across the country…”
The same study by the Commonwealth Fund states the following: “Health insurance has historically been regulated by the states. Therefore, insurers seeking to offer policies in multiple states must comply with each state’s insurance regulations. Prior to the ACA, state insurance regulations varied widely, particularly with respect to underwriting, guaranteed issue, and coverage denials. The ACA established minimum standards, but if the law were repealed, the significant regulatory variation across states would likely return. Although details have not been fully specified, this policy would allow insurers in one state to sell plans in state without complying with the other state’s regulations.”
Now, this does seem like it would have the opposite effect and would, in fact, make it harder for those Americans with pre-existing health conditions to have continued coverage.
However, Trump did recently offer a provision to his health-care policy stating that he would work with state governments to set up high-risk pools. The policy listed here on his website, claims to “ensure access to coverage for individuals who have not maintained continuous coverage…”
3. “Allow Individuals to Fully Deduct Health Insurance Premium Payments From Their Tax Returns”
Another provision that President-Elect Trump has embraced is the ability for individuals to fully deduct health insurance premium payments from their tax returns.
“Current laws and provisions outside the ACA exclude employer spending on health insurance from income and payroll taxes. However, prior to the ACA, the significant tax advantages available to those with employer-sponsored coverage did not extend to those enrolled in private, individual-market policies obtained outside of an employer. The ACA began to bridge this gap by providing means-tested advance premium tax credits (APTCs) for purchasing individual market insurance. Trump’s proposal would eliminate APTCs, and allow individuals to use pretax dollars to purchase individual market insurance.” (Source)
4. Pharmaceutical Companies Subject to Less Federal Regulation (Source)
The pharmaceutical industry received a potentially huge boost with a Trump victory. Hillary Clinton had been extremely critical of drug companies and promised strict regulation of both drug and biotechnology companies.
President-Elect Trump’s position on regulating drug prices is still uncertain. However, he has mentioned allowing Medicare to negotiate with drugmakers as well as allowing for free markets, specifically the importation of foreign drugs, to allow for price reduction and consumer options.
An additional point worth mentioning is that the Affordable Care Act provided biosimilar drugs a pathway to compete with existing drugs, reducing pharmaceutical costs in America by as much as $250 billion. Of course, this provision would be in jeopardy if President-Elect Trump does decide to repeal Obamacare.
5. Concerns About Biomedical Research & Development (Source)
According to NPR, “The federal government spends more than $30 billion a year to fund the National Institutes of Health. That’s the single largest chunk of federal research funding spent outside the Pentagon’s sphere of influence.”
And while drug and biotechnology companies may be encouraged by a Trump presidency (See Above), the same cannot be said for universities and other government-funded research entities.
In fact, Trump’s actual campaign has said very little about scientific research and health research in particular.
Tanisha Carino, Vice President for U.S. Public Policy at GlaxoSmithKline, thinks that “the fact that he did not take an ideological position may be a positive thing…” in the sense that President-Elect Trump may be more open to influence by leaders in the field.
However, one potential negative of a Trump cabinet is an isolationist, nationalist, foreign policy. Carino notes that science is international in nature. It works best when different countries and different communities contribute together to achieve discovery. To illustrate this point, Carino mentions antibiotic resistance as one of the most pressing global issues, due to various drug-resistant strains emerging all throughout the world.
An interesting thing to note is that Newt Gingrich, who is very close to President-Elect Trump, has long been proposing significant funding for all medical research. With his name floating around for a possible cabinet appointment, this could be a significant boon for healthcare research and development.
Finally, Tom Leary, Vice President of Government Relations at the Healthcare Information and Management Systems Society (HIMSS), says the following, “I do believe that the House and Senate
are still very much interested in ensuring the U.S. maintains its high level of superiority in biomedical research and the tenants of the Cures Act (21st Century Cures Act), whether it’s passed now or a newer version comes up in the new year, is really to keep the U.S. at the forefront of biomedical research, well into the 21st century. That’s bipartisan and bicameral, that’s a national priority.” (Source)
6. Decreased Immigration and Global Trade Could Directly Harm the Technology Industry (Source)
Like research, the technology industry often recruits highly skilled workers from abroad. Engineers, coders, and others make up a large part of the workforce for places like Silicon Valley and other tech hotspots around the country. In fact, Facebook CEO Mark Zuckerberg and Yahoo CEO Marissa Mayer have lobbied for increased immigration of foreign skilled workers.
According to an article in the Los Angeles Times, President-Elect Trump has previously come out in support of skilled immigration. However, he has stated his opposition to H-1B specialty nonimmigrant visas, which is a primary way for skilled immigrants to enter the country.
In addition, Trump’s seven point plan for free trade is a major concern for those businesses that operate overseas. Dan Ridsdale, head of technology at Edison Investment Research, says that, “Companies such as Apple, for whom China is an important export market, may well suffer from the backlash…”
As technology becomes more and more integrated into healthcare, policies on immigration and trade could have a significant impact on the industry as a whole. Some health technology and IT companies rely heavily on foreign skilled labor, while some even operate outside the U.S.
7. Investor Uncertainty
As Trump inched closer and to closer to victory on election night, the stock market plummeted due to the unpredictability of what a Trump presidency could mean. The unexpected victory has created a shroud of uncertainty for investors.
As a rule, investors tend to avoid uncertainty and stay risk averse during these times. This could mean a huge drain on investment into the healthcare industry, whether it be in technology, research, education, or others.
While this is a concern, It is still important to remember that President-Elect Trump has not released any of his policies related to technology or research and therefore, it may be premature to make judgments about investors and potential investments this early on.
Conclusion
The important thing to remember with all of this is that so far it’s just educated speculation. We don’t know what the Trump presidency actually means for the healthcare industry. Until Trump appoints his cabinet, takes office on January 20th of 2017, and starts to initiate his policies, will we get an idea of where the future of healthcare is headed?
