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ELECTION
IMPACT
The Next Chapter of U.S. Health Care
Speculative Assessment of Where Health Care
is Heading after the 2016 Election
By Alex Kenton, MD
A great deal of speculation has been made by healthcare experts fusing to insure an individual due to pre-existing conditions, and
on what will happen to health care with the incoming Republican
Congress and Administration. Indeed, it is difficult to say with cer- he intends to maintain the mandate that those who are insured
tainty what will happen, but my goal is to share my general assess-
ment of where things will go in the next four years so our physician under their parents plans can keep those plans through age 26. Even
community can prepare.
if full repeal of the ACA and the insurance subsidies are delayed by
It’s important to remember that when it comes to health care, all
is not won nor lost with the results of state and national elections. two to three years, it is likely that premiums will be higher for every-
Indeed, there is great opportunity for physicians and patients to suc-
cessfully navigate this new healthcare world, but for many others one, perhaps more so than what has occurred already. The result of
there are great challenges. The Affordable Care Act (ACA), the Sus-
tainable Growth Rate fix, and the coming revisions under a new ad- those higher premiums combined with the repeal of the insurance
ministration will ultimately create some of the most extensive
changes we have seen in health care to date. Over the next four years, mandate and associated tax penalties assessed to those who chose to
the changes coming will ultimately lead to a three-tiered healthcare
system, which include a limited government-run safety system, a go without insurance will be that many people will choose to be
private insurance program, and a cash-based fee-for-service system
for those areas not covered by the other two systems. The changes uninsured. Other additional pressures forcing more people to the
heralded by the incoming Republican leadership will likely solidify
the three systems for the foreseeable future. uninsured or underinsured pools will be the scaling back of the ex-
COVERAGE: panded Medicaid provisions, the elimination of subsidies to insur-
It is likely that changes coming to our health care system will re-
ance companies, the reduction of subsidies for individuals, and the
sult in more people being under-insured or uninsured. Although
President-elect Donald Trump intends to work with the Republican removal of many of the price controls and value based initiatives
Congress to scale back the provisions of the ACA, he intends to pro-
tect the legislation which prohibits insurance companies from re- which were all founding constructs of the ACA.
The positive result of these changes, however, is that there will
likely be the return of a variety of health plans to suit consumer de-
sire. The removal of the Cadillac Tax (a tax on employer-sponsored
high-cost benefit plans) will result in the return of more compre-
hensive plans for those who can afford them, while those who wish
for some coverage rather than none will one again have catastrophic
coverage models and high-deductible plans as available choices. Self-
pay, fee-for-service offerings by physicians and hospitals will flourish
under this program, especially with the planned expansion of tax-
deferred health savings accounts. It is also likely that some sub-spe-
cialty services and concierge services will thrive under this
environment.
continued on page 16
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