Donald Trump was elected the 47th president of the United States on Nov. 6, and 12 leaders joined Becker's to discuss what this could mean for physicians.
Question: What does a Trump presidency mean for physicians?
Editor's note: These responses were edited lightly for clarity and length.
Jim Augustine, MD. Emergency Physician and Clinical Professor in the Department of Emergency Medicine at Wright State University (Dayton, Ohio). In my time in Washington, D.C., I learned that very little of the healthcare field related to practice, oversight and payment, is under the direction of the president. The bureaucrats that oversee healthcare have a life of their own, and are not under the influence of whoever the president is. The federal bureaucracy right now is markedly anti-physician, and I would suggest that the policies directing the practice, oversight and payments will continue to be unfriendly to physicians and hospitals and other providers of acute care. Payment decreases will continue, "quality measures" will be ever more onerous and physicians will be under more mandates and higher fees for anything that relates to practice. The federal government will continue to promote palliative care, and have to correct serious deficiencies in our senior care facilities and systems. They will support increases in nursing education, and the number and practice of advanced practice providers.
Despite terrible behavior by commercial payers, like the No Surprises Act, and the windfall for United Healthcare due to the Change Healthcare breach, they will be allowed to continue their sprint to enrich themselves and punish providers. The tort system is unlikely to be corrected, except at the state level. That will support physician practices in some states, and displace physicians from other states.
Seref Bornovali, MD. Internist in Cincinnati: We know that Democratic administrations' response to physicians' complaints about regulatory burdens is to increase regulatory burdens. So far, they have not been successful in making it easy for doctors and patients. From this standpoint, I believe the past attempts of the Trump administration toward reducing regulation are promising. On the other hand, the GOP typically sides with big business entering medicine, which is one of the main reasons for physician dissatisfaction and burnout.
The president-elect has a certain level of personal unpredictability in addition to his current association with people with known positions against science and scientists in general. I find it very difficult to develop any specific expectations at this time.
Diana Everage, BSN, RN. COO of Bloomington Medical Services (Wooster, Ohio): While there were many health campaign topics discussed during the current election process that are important, the greater focus should be on the larger picture of healthcare. Trump winning the presidential election gives him the opportunity to impact healthcare. However, for this to be positive, the administration must look for the root causes of health issues for Americans and develop policy to support changes in multiple areas, including healthcare payment structures, nutrition and education.
Also, a significant need will be to address the ongoing Medicare reimbursement cuts to physicians/professional payments that have become annual and are contributing to the closure of medical practices and hospitals. The financial and administrative burden placed on healthcare providers by insurance companies should be reviewed, and consistent, transparent policies should be required.
Anne Galvi, MD. Physician Advisor with Revenue Cycle at Northern Arizona Healthcare (Flagstaff): My "hopes" would be:
- The Affordable Care Act to be overhauled for the better.
- Medicare Advantage plans to be held accountable to follow CMS rules. Stop these delays for authorizations and claims payments.
- Reduction in prior authorization requirements, and reduction in denials, especially for inpatient status stays. Full disclosure of when AI is used to process claims/appeals.
- Full disclosure of when unlicensed, non-medically trained staff are involved in UM processes across the continuum of care.
Paul Krakovitz, MD. ENT in Salt Lake City: From an economic macro level, I do not think it will have much impact on physicians. The ACA is likely to be left in place. CMS funding to physicians will largely be unaffected by the president. I think it is unlikely we will see policy changes that significantly impact the headwinds physician practices are facing. The consolidation of practices by large health systems has a much larger impact on physician compensation and payment rates than government policy.
At a clinical level, the potential for change is greater. The promise of decreased regulations could make day-to-day practice simpler. However, the highest clinical risk I see is a removal of institutional regulations on vaccinations. The significant decreases we have seen in RSV hospitalizations could be reversed. Additionally, vaccine-controlled infections that are rare could return.
Scott Lauter, MD. Healthcare Leadership Development Consultant in Lewes, Del.: I am hopeful that annual Medicare physician fee reductions will end. I am concerned about the potential influence of a non-physician, RFK Jr., on federal healthcare policy and on federal public health and research agencies, CDC and NIH. I would hope that we will continue to move in the direction of value-based care and continue working to address health inequity.
Peter Nalin, MD. Head of the Department of Family Medicine and Biobehavioral Health at the University of Minnesota Medical School, (Duluth): Whenever a change of presidential administration occurs, along with the new Congress, physicians can renew their educational efforts and advocacy on behalf of medicine, healthcare and patient health to our senators, representatives and the White House. Trends favoring public-private partnerships, mergers and acquisitions, protections for professional ethical conscience, and more AI-incorporating innovations in medicine can be anticipated. The need to reduce administrative burdens and overhead expenses associated with care delivery and insurance, along with curbing inflation rates on medical supplies and business costs, would help physicians during the current era of margin reductions that contribute to the overall trend of physicians as employees.
Scott Needle, MD. Chief Medical Officer of Woodland (Calif.) Clinic Medical Group: Right now, there's still a lot of uncertainty in healthcare, especially regarding the future of Medicare Advantage, value-based care and physician compensation. Based on past Republican priorities and proposals, it's reasonable to anticipate attempts at reducing federal spending — particularly via Medicaid block grants and cuts to ACA subsidies, which will increase the number of uninsured and make it significantly more challenging to provide care to underserved populations.
There'll likely be a rise in uncompensated emergency department care, and more people will defer or go without care altogether. Private insurance will be deregulated, allowing products that offer highly limited coverage in an attempt to lower premiums. These plans will be great if you're healthy and stay that way; if you have chronic conditions, expect higher premiums, higher out-of-pocket costs, and challenges in getting or keeping coverage. Individual medical practices could see a decreased regulatory burden, but overall I expect it will be harder for us as physicians to ensure people get the care they need. We'll need to continue to advocate for our patients and do our best to work with our policymakers to improve the American healthcare system.
Kenneth Peach. Partner at MobileMedix Plus (Windermere, Fla.): The physicians with whom I have been speaking suggest that a Trump presidency represents a move toward market-based solutions over government solutions. Despite the current benefit reductions and health plan/hospital reimbursement challenges, they expect to see an expansion in Medicare Part C instead of traditional Medicare. They also mention a possible return of opportunities to financially invest in delivery system components (i.e., micro-hospitals, medical office buildings, telemedicine services). While they believe the ACA will face major challenges, there is uncertainty until the control of Congress is determined regarding how successful potential changes will be.
However, regardless of who had won the election, the primary care physicians we serve continue to seek autonomy through direct primary care, ACO affiliation, or same-specialty medical group practice independent of the hospitals.
Robert Pearl, MD. Stanford (Calif.) University Medical and Business School Professor: It is too early to know what the next president will do or how Congress will respond. We don't yet know which party will control the House. And history tells us that how candidates campaign often differs from how they will govern. Overall, we can expect a weakening of regulatory oversight by agencies like the FDA, CDC and FTC. Additionally, there is likely to be easing of restrictions on states' choices regarding Medicaid policies and businesses' implementations of coverage mandates. It is also probable that fewer Americans will have coverage in the future than today. The impact on physicians will depend on the state in which they are working, the nature of their practice and the population they serve.
Thomas Stover, MD. Retired Physician Executive: I think there are a few key changes related to this major change expected from this new White House.
- A hopeful end to proposed cuts on Medicare physician pay rates.
- A possible relaxation of the physician-owned hospital moratorium.
- The potential repeal of much of the Stark law, given the current environment of employed physicians.
John Swicegood, MD. Anesthesiologist in Fort Smith, Ark.: In my career, I’ve seen what I can only describe as a cartel of Medicare/Medicaid, insurance companies, hospitals and big pharma completely taking over healthcare access and healthcare choice. This has destroyed physician autonomy and private practice. CMS remains a bloated, unaccountable bureaucracy that controls access and pricing with insane and ever-increasing regulations, social agendas and fee cuts. Trump appointed RFK Jr. to address this. The mainstream media has portrayed him badly, but I think he's not the nut he is made out to be. It could be that he will dismantle this behemoth, which only serves to exploit patients and physicians, and return healthcare back to a physician-driven model.
Don Taylor. Clinical Professor of Healthcare Leadership & Management at the Jindal School of Management (Dallas): Based on my readings and discussions with physicians, I believe there may be a few initiatives that will impact healthcare and physicians.
First, transparency of pricing, which was a focus of the first Trump administration, will likely continue. There is a chance that this may also include transparency of performance, quality and safety for patients to make better care decisions. The assumption is that informed choice will improve competition and encourage overall system improvement. Second, reduction of waste, regulation and bureaucracy will be a major effort to drive "waste" out of our complex healthcare system. This may even drive welcomed simplification. This may also include reviews of HHS, the CDC, public health, the FDA and other government healthcare entities. The reviews will be focused on finding efficiencies, improving safety and addressing the problems we identified from the COVID-19 pandemic. Third, pharmacy will continue to be a focus of cost reduction as it has been in recent years. Fourth, I expect a new focus on "health" based on recent statements and interviews. This may include more attention to prevention, nutrition and public education. Lastly, I expect that many healthcare policy issues will be determined by the states instead of centralized in federal agencies. Overall, there will be change, but I am not certain how fast or intense it will be.