A Framework for Predicting the Trump Administration’s Health Policy Moves

In the wake of the 2016 U.S. presidential election, most pundits and pollsters admit that they don’t know what will happen under the administration of President-elect Donald Trump. 
To many, he seems unpredictable.

Healthcare policy may be an exception to the unknowns. If one lays aside the most hyperbolic campaign rhetoric, puts the various substantive policy proposals of the Republican party and Trump in boxes, and looks for what is most repeated, the fog begins to clear and we see that health care is a priority, involving 11 specific targeted policies.

The Five Boxes

The most substantive and recent aggregations of healthcare policy positions from the Republican party or Trump include:

• Paul Ryan and House Republicans’ “A Better Way” plan, released on June 22, 2016, often referred to as “the Ryan plan”
• The Republican National Committee’s “Republican Platform 2016,” issued on July 19, 2016
• The “Health Care” section of the Donald J. Trump for President website
• “Donald Trump’s Contract with the American Voter,” delivered at Gettysburg, Pa., on Oct. 22, 2016
• Trump’s healthcare plan, released on Nov. 10, 2016, and certain post-election comments.

The Most Common Policies

For years, “repeal and replace” has been the repeated refrain of the Republican party and Trump with respect to the Affordable Care Act (ACA). So not surprisingly, all five of the major Republican plans call for such action, as do three policies designed to replace the access provisions of the ACA:

• Increasing the focus on health savings accounts, tax-advantaged savings accounts that can be used to pay for certain medical expenses
• Allowing people to purchase insurance across state lines in all 50 states
• Transforming federal funding of Medicaid into block grants so the onus for managing the program falls on the states

Retaining Popular Features of the ACA

In spite of Republicans’ highly critical comments about the ACA, both the Ryan plan and post-election comments by Trump acknowledge the importance of maintaining two widely popular elements of the law: allowing young adults to the stay on their parents’ health plans until the age of 26, and requiring health insurers to cover people with preexisting health conditions.

Other Policies

Although they do not appear in all five boxes and fewer details about them have been provided, there are five salient goals common to the Ryan plan and Trump’s healthcare plan:

• Providing financial support from the federal government for people in state-run high-risk pools who find themselves priced out of health insurance coverage
• “Modernizing” Medicare by allowing private health plans to compete with traditional fee-for-service Medicare, providing individuals with a premium support payments to help cover the cost of premiums
• Cutting red tape at the Food and Drug Administration to expedite the approval of life-saving medications
• Protecting individual conscience in health care, allowing providers the freedom to exercise their conscience, such as deciding not to deliver abortion services
• Applying the Hyde Amendment, which mandates that federal taxpayer dollars not be used to pay for abortion or abortion coverage except in certain circumstances

Republican and Donald Trump Proposed Health Policies

“Trumpcare”

What some have started calling “Trumpcare” clearly will be more state-run and market-based than the current system.

In spite of the unfairness in comparing the 37-page Ryan plan with the 310-word Trump healthcare plan, not to mention past tensions between the Speaker of the House and the President-elect, the 11 policies highlighted here are mentioned in both pieces.

Still, even with Republican majorities in both the House and the Senate, it is unrealistic to expect that all of them will become law. The devil will be in the details of legislation produced by congressional Republicans. Trump, an admitted political novice, will need to learn how to practice the art of the possible, the Beltway’s version of the art of the deal.

Ken Perez is vice president of healthcare policy, Omnicell, Inc., Mountain View, Calif., and a member of HFMA’s Northern California Chapter.