Is Trump good for healthcare? Not so fast

At first glance, physicians in private practice may assume Donald Trump will be good for healthcare. A businessman who does not like government intervention seems like a dream come true. Hopefully, intrusions into patient care such as Meaningful Use and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be history and all may be better with the private practice of medicine. No so fast.

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If it were an organized business, healthcare in America would be the largest enterprise in the world in terms of revenue. The $3.8 trillion healthcare industry is fueled by public dollars, mainly Medicare and Medicaid, and by commercial health insurance. The out-of-pocket payments by patients account for only about 20% of healthcare spending-a percentage that’s rising, but overall still small by comparison.

Trump wants to “Make America Great Again” by investing in infrastructure, e.g. highways and bridges, and the military. He also wants to cut taxes. Where will the revenue to pay for all this come from? I believe healthcare is a likely target.

I suspect the massive medical industrial complex is in for some reckoning and likely a recession under Trump. That is not all bad from a broad social perspective. Those of us in primary care have little sympathy for medical waste and inappropriate care. However, reduced spending in healthcare is likely to impact everyone dependent on payments from Medicare, Medicaid and private insurance. About half of physicians, including those in primary care, work for health systems likely to be impacted by decreasing revenues.

Next: Interesting to see what happens to well-organized health maintenance organizations 

The free-market capitalism favored by the president-elect may be good for direct primary care (DPC). In DPC practices, patients recieve a high level of primary care with longer visits and direct access to the personal physician and team, bypassing the often frustrating access of high-volume busy practices. Such patients usually have a high-deductible health plan for catastrophic care and major medical needs. Trump supports Health Savings Accounts and I speculate he would support any model of care that allows patients to directly pay for care.

Hot topic: Obamacare rising costs creating challenges for physicians

It will be interesting to see what happens to well-organized health maintenance organizations under Trump, such as Kaiser and Geisinger. As long as these plans remain competitive for employers, Medicare and Medicaid, they are likely to continue. However, they may face decreasing revenue or resort to higher deductibles in a tighter market with revenue reductions. They would have to compete with unregulated high-deductible health plans offering a narrow range of covered services that will be less expensive.

All the opinions expressed here are speculation and no one really knows the journey ahead in healthcare under Trump. We know that Medicare and Medicaid will shift to more unregulated environment, creating uncertainty. Health insurance will have fewer restrictions and hence may become less generous, pushing such services such as family planning to cash payments. We are in for an interesting ride indeed.

Joseph E. Scherger, MD, MPH, practices family medicine in La Quinta, California, and is a member of the Medical Economics Editorial Advisory Board.