Secure Your Aprons: Healthcare Reform Takes The Presidential Election Front Burner

With the presidential election less than a month away, we’re all asking ourselves the big question: How will healthcare be impacted? Regardless of the fact that both candidates’ views on the future of the U.S. health system are basically on opposite ends of the spectrum, one thing they can agree on is that healthcare reform will be at the forefront of 2017. It’s no mystery that Americans are suffering – both patients and providers. Patients are paying more out-of-pocket costs than ever, also suffering the Obamacare “glitch”, associated with the error that doesn’t accept employee families when determining subsidies. On the other hand, providers are faced with the numerous changes related to the move to value-based payment, rising pharmaceutical costs, and the growth of healthcare consumerism.

Among the many tribulations facing the industry, there are a few standouts in both candidates’ policy statements. Those being the future of the Affordable Care Act (ACA), Medicare, Medicaid, and the looming issue of rising pharmaceutical costs. Each candidate has laid out the framework for their proposals, so let’s cover those in the simplest of terms.

What will happen to the Affordable Care Act? Under Hillary Clinton, the ACA will be preserved and expanded to include uninsured families, regardless of immigration status. Her overall plan is to improve its market function, offering additional subsidies to consumers to make premiums, out-of-pocket costs, and prescription drugs more affordable for all.

Under Donald Trump, he will attempt to repeal the ACA and replace it with a series of proposals encouraging free-market competition. He’s very much in favor of eliminating governmental mandates for employers and individuals, requiring every person to purchase health insurance or face penalties. In order to increase patient/customer satisfaction and lower costs, he proposes to allow health insurance companies to compete across state lines, as long as the plans comply with existing state regulations.

What about Medicare? If Clinton wins, she will push heavily for the continued shift to value-based reimbursement models, such as bundled payment and accountable care. As far as affordability, she may attempt to pass her proposal allowing Americans to voluntarily enroll in Medicare when they turn 55.

Under Trump, he’ll push to transform Medicare into a premium support program, meaning the government would make fixed per-capita contributions and beneficiaries use those payments to get their care from either traditional Medicare or private plans.

How will Medicaid be affected overall? Under President Clinton, she will support President Obama’s proposal, attempting to expand Medicaid to those 19 states that haven’t done so. Her proposal will allow any state that signs up for Medicaid expansion to receive a 100% match for the first three years. In terms of cost efficiency, this will cover low-income adults in states that have not yet expanded. This could potentially incentivize those non-expansion states to extend coverage. She also plans to fix the “family glitch,” a six-year Obamacare issue associated with the error that doesn’t accept employee families when determining subsidies. So, if an employer offers affordable insurance but doesn’t offer it to the family, they won’t be able to get subsidies through the exchanges.

Under President Trump, states will receive “block-grant” funding for Medicaid, which means that money for Medicaid will be appropriated to the states to determine how best to spend it based on their needs. This appropriation would reduce federal involvement and increase power of individual states to manage their own programs. Incentives would be provided to seek out and eliminate those that choose to abuse the system. This could also give state leaders enormous freedom to set eligibility, benefits and program structure.

How will pharma cost controls be impacted? There’s no doubt that this is one of the largest ongoing issues for all Americans concerning healthcare. Hillary Clinton has proposed a pharmaceutical company crackdown for rising prices, awarding them for investing in research. Part of her plan is to demand that drug costs are lowered for middle-class families and seniors, basically capping out-of-pocket costs for prescription drugs.

Trump plans to promote pharmaceutical cost reduction through free-market principles. This plan proposes the removal of barriers to entry into free markets for drug providers, as long as they are deemed safe and reliable. He has also proposed allowing consumers to have greater access to imported drugs from overseas.

As a medical professional, or simply a patient, you have personally witnessed how rapidly the industry is transforming. Nothing seems certain, except for the continuing change to healthcare which will undoubtedly press on no matter who wins the November election. Hopefully this post has given you some insight into how the industry will change within the next few months, and how you may be affected. 


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