The Leadership Development Group: 6 takeaways about what 'Trump versus the ACA' means for healthcare

The ACA ushered in a new era of healthcare in America. As Congressional Republicans and President Donald Trump's administration attempt to repeal and replace the health law, payers, providers and other healthcare organizations are questioning how proposed changes will affect them and the healthcare industry at large.

Kent Bottles, MD, CMO of PYA Analytics, discussed the issue during a webinar hosted by The Leadership Development Group titled "Trump versus the ACA" on Feb. 21. He spoke about how different proposals Republican lawmakers have put forth would change key aspects of the ACA, and the effects those changes may have on the industry.

Here are six takeaways from the webinar.

1. Eliminating the individual mandate. Dr. Bottles said the ACA's individual mandate is likely the most unpopular component of the law among Republicans. While President Trump said he wants to maintain parts of the ACA, such as the elimination of preexisting conditions, Dr. Bottles said it is difficult to see how the healthcare costs of an individual with preexisting conditions would be offset by allowing younger, healthier individuals to forgo purchasing health insurance.

2. Uncertainty in the individual market. Dr. Bottles said uncertainty surrounding whether the ACA will be repealed sans replacement or the kind of replacement plan that would be implemented may make insurers leave the individual market. While CMS released proposed regulations to stabilize the individual market, he said other moves such as President Trump's executive order on the ACA and the Internal Revenue Service's decision to stop rejecting tax returns where the filer does not fill out their health coverage status are sending insurers mixed signals. 

3. Cutting Medicaid expansion and disproportionate share hospital payments. As part of the negotiation to approve the ACA, hospitals gave up $350 billion in disproportionate share hospital payments they received to compensate low-income and uninsured care. If Medicaid expansion under the ACA is eliminated and the disproportionate share hospital payments are not reinstalled, "hospitals [would be] the big losers," Dr. Bottles said. He said hospitals need to do some scenario planning to prepare for either outcome.

4. Selling insurance across state lines and physician networks. With insurers shifting networks toward a narrow group of physicians, selling insurance across state lines may require policyholders to travel farther to receive in-network care, Dr. Bottles said.

5. Medicare Access and CHIP Reauthorization Act. While MACRA isn't part of the ACA, it follows the ACA's philosophy of "no outcome, no income," Dr. Bottles said. Rep. Tom Price, MD, (R-Ga.), head of HHS, has said he doesn't like MACRA, while Seema Verma, CMS acting administrator nominee, has spoken out against bundled payments and ACOs, according to Dr. Bottles. Although Dr. Bottles said he doesn't think MACRA will be replaced, he said its future remains uncertain.  

6. Some trends to stay. Dr. Bottles said the shift from inpatient to outpatient services will most likely not change under ACA repeal and replacement. He also said millennials' consumer approach to healthcare will continue. 

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