Trump Election Creates Unpredictable Environment For Healthcare
In the uncertain times that lie ahead, seismic regulatory changes flavored with reactionary populist notes frame the environment awaiting the healthcare community.
It’s difficult to figure how and when a Trump presidency will affect healthcare nation. At this early stage, speculation is the only prism available and Trump’s policy detail is vague at best.
The Affordable Care Act
The fate of the Affordable Care Act is as good a place to start as any. Trump has been promising to scrap the ACA and replace it with something better since early in his first term. His latest pronouncement down the stretch in ’24 is that he and his team have “the concepts of a plan” gathered and will put it all together soon. For the time being, Obamacare could benefit from repeated stays of execution. The ACA has gained enough traction during the past eight years to make it tougher to kill than it was a decade ago.
Medicaid & Medicare
Trump has promised to protect Medicaid, Medicare and Social Security, again without explaining how. Politically, these programs would be difficult to gut, but Medicaid and Medicare are arcane enough programs to subtly snip at some point, should it become politically expedient. During his first term, Trump flirted with promoting low-premium, low-coverage plans, and consumers aren’t always aware of serious weaknesses or scant coverage in plan design.
Bureaucratic Expertise
At the end of his first term, Trump began a purge of the non-partisan, civil-servant bureaucracy, to remove independent policy professionals and replace them with Trump loyalists. He was interested in removing obstructions to politically motivated policy changes by swapping experts, in some cases with decades of experience, for political operators that would do his bidding.
Healthcare bureaucrats might not be immediately in the direct line of fire, but if complex policy considerations stand in the way of a politically expedient maneuver, bureaucratic substitution could come into play.
Abortion
In an ironic situation that proves truth stranger than fiction, several states that elected Donald Trump president also passed referenda enshrining abortion rights in their Constitutions. But some did not, leaving women in those states without access to a critical healthcare service and limited in choices about their bodies. The situation is not helped by characteristically vague positioning on the issue by Trump throughout the campaign.
Clear As Mud
Like so much in Trump’s policy canon, aspects regarding healthcare are unclear and shift depending upon the context or political purpose at play. Also unclear are whether or when those “concepts of a plan” will gel.
The end of the ACA, much like Trump’s tax returns and so much else, seems to become corporeal when convenient and recede into the mist when not, which leaves those providing and administering healthcare in an unenviable position.