Paul H. Keckley, Ph.D., is managing editor of The Keckley Report, a health care researcher and widely known industry expert. In addition to The Keckley Report, he authors a monthly column for Hospitals & Health Networks and has published three books and 250 articles. During the period preceding the passage of the Affordable Care Act, he facilitated sessions among the White House Office of Health Reform and major health industry trade groups as private sector input was sought in the legislation.
Next week at Cerner Health Conference, Keckley will share his reflections on the election, the focus of the Trump administration and 115th Congress and the megatrends facing our industry and Health Reform 2.0.
Special Post Election Edition: Reposted from The Keckley Report
November 9, 2016
The election results are in, and Donald Trump will be the 45th president of the United States. His appeal to “Make America Great Again” resonated across the heartland, sparking an unprecedented political upset that surprised even the most astute prognosticators and pundits.
When he takes office in January, he’ll face enormous challenges domestically and globally. Health care will be at the top of the list: he promised to “repeal and replace” the Affordable Care Act (ACA), and he pledged changes that strengthen the system in his campaign’s 7-point plan. In this effort, his team will face harsh realities:
Total health care spending will increase 6 percent annually for the next decade. Utilization is up. Demand is increasing and traditional reimbursement is not keeping pace with underlying costs. That’s not sustainable. Something’s got to give.
Health care is no longer a cottage industry. Mega deals across the board are pending, like Anthem-Cigna, Aetna-Humana and more. And in most communities, half of the physicians are employed by hospitals that are affiliated with multi-hospital systems. The health system’s future will play out against new ways of competing.
With MACRA payments to physicians and mandated bundled payments for heart failure, coronary artery surgery and joint replacements for hospitals coming on line next year, providers are anxious. What’s next? What’s their future?
Investors are flocking to startups that challenge the status quo in health care. Their ranks include retail clinics, micro hospitals, telemedicine, urgent care centers, disposables, smart implantables, hybrid insurance models and others that challenge stakeholders to innovate faster and more effectively. It’s a huge industry that’s historically made its own rules and kept outsiders out. That’s changing.
Half believe it a necessary impetus for expanding insurance coverage and lower costs, and half feel it’s an overreach by federal bureaucrats that want a government-run health system.
Details about the Trump health care agenda are not clear, but the campaign promised to repeal and replace the ACA on his first day in office. With majorities in both houses of Congress, the vehicle whereby the law can be changed is straightforward: the bigger questions are how it is to be replaced.
After the vote, it’s likely a series of administrative orders and targeted legislation will follow that begin the process of undoing the ACA including,
It’s likely the Trump team will advance other proposals, like allowing for the importation of prescription drugs, but the mechanisms whereby these are enacted is problematic.
The first 100 days of an administration are marked by three major activities: 1, political appointments to the cabinet, key agencies and programs; 2, deals with Congress to set a tone for lawmaking to see who’s in charge; and 3, posturing to garner public opinion gains.
Appointments: A new administration has 4,000 political appointments to make, including more than 200 in key health care slots. Since cooperation with states will be central to the new administration’s health strategy, the HHS cabinet position is likely to be filled by a former Republican governor with state health care officials filling many of the key slots. Dr. Ben Carson, a former presidential candidate himself, is likely to play a key role along with other campaign operatives in their selection.
Deals: The new administration and Congress will advance bills to eliminate the Cadillac tax on employers and medical device tax as a start. With the composition of a supportive Congress, the low-hanging fruit includes ways to improve veteran’s health programs and potentially legislation to control drug prices.
Posturing: The honeymoon for a new administration is short, particularly one elected in a bitter campaign season in which distrust for the leading candidates was the central issue. The Trump team is unknown on Capitol Hill, so uncertainty abounds. Confirmation of cabinet appointments will surface how battle lines are drawn. The confirmation of the Supreme Court vacancy left by the death of Justice Scalia will be huge, symbolically, as ideologues flex their muscles.
Campaign 2016 was far from ordinary. There remain many unknowns, especially about health care.
So, what does all this mean for the stakeholders in the industry — the providers of services, the intermediaries who organize networks and negotiate rates, and the manufacturers of the drugs, technologies and “stuff” we use?
Campaign 2016 is now history. President-elect Trump’s business savvy will no doubt be the underlying theme of his administration. It will be put to the test at home and abroad, and especially in our health care system.