6 thoughts on how healthcare under Donald Trump may affect hospitals

Six healthcare leaders discuss President-elect Donald Trump's healthcare plans and how they could affect hospitals in the future.

Responses have been edited for length and accuracy.

Ted Chan, Founder and CEO of Caredash.com (Boston): "The unraveling of Obamacare seems likely to happen. Healthcare expenses are still growing. As additional reforms take place, hospitals, physician practices, doctors, insurers, pharmaceutical companies and medical device players will again have to fight through uncertainty for elbow room through the complexities of transfer pricing, compensation and profit taking/sharing. The switch and the ramp up took time for everyone, and turning the ship again will be complex with a lot of overhead.

I believe at the end of the day rolling back healthcare reform will redistribute costs since people won't stop getting sick. Before Obamacare the uninsured went into hospitals or had emergencies just the same and couldn't usually pay. People went broke or hospitals absorbed the cost. Under Obamacare hospitals were paid for these services and could budget and staff appropriately. These costs will get passed back to consumers and companies."

Michael T. Dougherty, CEO of Provident Consulting (Farmington Hills, Mich.): "ACA repeal will definitely bring uncertainty to hospitals and other players in the sector that have benefited from increased insurance coverage. To avoid disruption, the replacement of health insurance exchanges, premium subsidies and change in the Medicaid system to block grants will need to be carefully phased. We do foresee continued support for pay-for-quality initiatives but with an effort toward simplification that may actually spur industry adoption. Bipartisan support for IT interoperability should remain strong. In any scenario, hospital systems will need to focus on compliant revenue capture and coordination across the continuum of care."

Nancy Lakier, Founder, CEO and Managing Principal of Novia Strategies (Poway, Calif.): "Healthcare has been and will certainly continue to be a focal point under President-elect Donald Trump. While we have historically seen bipartisan support for the need for healthcare reform and the need for accountability of care, the differences centered around payment structures. The shift under the ACA has been from volume- to value-based care, and hospitals were reimbursed for new volume under the ACA.

With this changing political landscape, we expect the reimbursement structures to change and the new volume payments will likely be in flux. For example, the potential partial or full repeal of the ACA; retraction of Medicaid expansion and the exchanges; and the probable increased competition among payers could substantively change payment models, though potentially not until 2018."

Erik Shannon, National Partner-in-Charge, Health Care Advisory Services of Grant Thornton (Houston): "President-elect Donald Trump has promised to eliminate the individual mandate to buy health insurance, a move that likely means a return to medical underwriting based on pre-existing conditions. It is anticipated these changes will increase the number of uninsured, which will impact all providers, but especially hospitals that have seen their [disproportionate share hospital] reimbursements cut.

Health plans that offer insurance products through state health insurance exchanges may see a very near-term impact. There's a risk that healthy individuals looking to buy insurance through state exchanges may opt out of the current enrollment process because they assume a President Trump will waive any penalties for not having health insurance. If this becomes a trend, then health plans will be insuring populations that are less healthy than they assumed when they set their premiums."

Zach Silverweig, Co-founder of CipherHealth (New York): "The Trump presidency will obviously bring great shifts to the majority opinion moving forward, especially in regards to healthcare policy. However, there is a component of healthcare that both political parties can agree on: making the patient experience consistently better. We expect elements of value-based payment models to stay through the Trump presidency, because they are pretty successful at driving down hospital costs while improving patient outcomes and satisfaction scores. Although value-based initiatives can be seen as a complex challenge by many hospitals, technology solutions exist to enhance the effectiveness of those initiatives."

Dan Steingart, Vice President of NFP Health Care of Moody's Investors Service (New York): "Trump's proposed repeal of the ACA would be credit negative for not-for-profit hospitals over the short term by exacerbating uncertainty regarding insurance coverage and eligibility. Once a new system is in place, expanded health insurance coverage through private insurance would have benefits and limitations, the severity of which would depend on the level of reimbursement. Given that most individuals in the U.S. would still require subsidies to purchase coverage, the level of reimbursement would further depend on the size of these subsidies.

Trump's proposal to move federal Medicaid funding to block grants and do away with the current matching system, whereby states and the federal government jointly fund the Medicaid program, would be credit negative for not-for-profit hospitals, owing to the limits on Medicaid funding and downward pressure on Medicaid reimbursement. A block grant program could also create pressure to curtail services that Medicaid covers. As previously covered services are cut, uncompensated care would rise for many not-for-profit hospitals. There likely would be a significant reduction in funding and cash flow for large urban hospitals, teaching hospitals and safety net providers that rely on supplemental funding."


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