Predictions for Healthcare in a Trump Era

Neda M. Ryan, Esq. 

Compliance Counsel, Anesthesia Business Consultants, Jackson, MI 

 Healthcare has been the talking point for generations, but its presence has been even more pronounced since President Obama’s election in 2008. Such discussions have revolved around passing comprehensive healthcare reform, passing the Affordable Care Act (ACA or “Obamacare”), repealing the ACA and replacing it with the American Health Care Act of 2017 (H.R. 1628) (AHCA) and failing to secure the votes to pass the AHCA in the House of Representatives. There have also been discussions regarding the future of healthcare enforcement, information technology security and transgender health protections. The common thread passing through each of these issues today is: what’s next?

Defeat of the American Healthcare Act

When President Trump was elected, industry stakeholders predicted the ACA would be repealed and replaced (many predicting in the first 100 days of President Trump’s administration). However, the House of Representatives Republicans were unable to pass their healthcare reform bill—the AHCA. In his remarks, Speaker Ryan said, “we will be living with Obamacare for the foreseeable future.” While President Trump says he has not put healthcare completely to the side, he said he will focus on his next priority: tax reform. So, with all of these shocking developments, many are left to wonder whether the ACA will, in fact, be comprehensively replaced. The answer: it is unlikely.

According to most Republicans, and as stated by President Trump, Obamacare “is imploding and soon will explode.” In the Wall Street Journal, Aetna’s CEO said the ACA was in a “death spiral.” As it stands, it is expected that insurance premiums will continue to increase and many of the larger insurance companies will pull out of the exchanges in 2018, thereby creating fewer healthcare coverage options for many Americans from which to choose.

Unfortunately, Congress is stuck in its own death spiral: the blame game over who will own the fate of the ACA. Republicans will continue to blame Democrats for passing the law seven years ago, while Democrats will blame Republicans for failing to come up with a viable alternative, all while knowing the law’s fate. What we do know is that this was a huge loss for Republicans and whether they will muster the courage (and votes) to propose another bill is yet to be seen.

Healthcare Enforcement

Healthcare enforcement has been on a steady and steep rise over the years, especially in light of the government’s expanded enforcement power under the ACA. In its most recent Semiannual Report to Congress, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) sought to recover $5.66 billion in investigative and audit receivables. This is $2.31 billion more than was recovered in 2015. Some question whether President Trump’s recent hiring freeze and focus on enforcement elsewhere (think: immigration) will impact healthcare enforcement. The answer: it is unlikely.

Although on January 23, 2017 President Trump issued a memorandum instituting a hiring freeze, the impact of it on healthcare enforcement is debatable. The statement of the hiring freeze was immediately followed by numerous exceptions, including those positions deemed by the head of the executive department or agency as “necessary to meet...public safety responsibilities,” as well as “those exemptions [that] are otherwise necessary” as deemed by the director of the Office of Personnel Management. Moreover, the memorandum “does not prohibit making reallocations to meet the highest priority needs...” In other words, so long as the positions are deemed necessary and/or agencies reallocate their resources to meet their highest priority needs, this hiring freeze will have limited impact on various agencies, including those that enforce healthcare-related laws and regulations.

On the campaign trail, then-candidate Trump was vociferous about his concerns with our current immigration system, vehemently expressing his desire to deport “bad hombres.” In fact, it was on this platform that he rose to such prominence and popularity in the early days of his campaign and, ultimately, won the election. Many question whether his public focus on our country’s immigration system will limit the Administration’s focus on healthcare enforcement. Although we expect to see a sharp spike in immigration-related enforcement, because of the great revenue generated by the OIG in recent years (and the rate at which such revenue generation has increased), the healthcare industry should expect the Trump Administration to continue the Obama Administration’s fervent enforcement of healthcare-related laws regulations.

Accordingly, anesthesiologists should continue to remain vigilant in their efforts to achieve, and remain, compliant with all laws and regulations affecting their practices, and to develop and improve their compliance plans furthering those efforts.

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