The Era of Trump: How the New Adminstration Will Affect the ACA

Today, we are going to do something we did last week and liked: look at several blogs all on one site.  This seems to give us a pulse of what people are thinking about and several perspectives to consider.  Going under the microscope today is The Healthcare Blog (THCB), where we have several articles about Mr. Trump winning the election and what that means for the Affordable Care Act (ACA), and insurance and healthcare in general.  What we will do is look at the articles individually, sum them up, and then provide commentary on their conclusions, and then our own.  If you are only going to read one paragraph, make it the last one, the conclusion.

The first article is Healthcare’s sky isn’t falling; President-elect Trump’s path forward, penned by Gary Mendoza.  Mr. Medoza is detailing what will and what won't change.  Here are the highlights: Mandated benefits and indirect cross subsidies will go away.  Inclusion of existing conditions and allowing children up to age 26 to stay on his or her parents policy will stay.

The second article, Dear Mr. President-Elect, about that Ryan Plan Thing, by Margalit Gur-Arie is basically a rant against the Ryan plan to reform health insurance and an admonition to avoid buzzwords like "Patient-Centered," "Value-Based," and "Transparency."  If you follow along with us you know that we despise buzzwords as smoke and mirrors that salesmen use to describe things they don't understand.  One great point here, though unsubstantiated, is Gur-Arie's statement that

"When you go to a doctor who runs his or her own small business, you pay half as much as when you go to a doctor that is employed by a large health conglomerate, and you get better care to boot."

It only makes sense that your personal doctor, in private practice, cares more about you as an individual patient, is lower cost due to not having to pay a big corporation for the privilege of a working for them, and make more money personally, for the same reason.  Voltaire has some interesting things to say about common sense, however.

The third article is where things get really interesting.  A Vote For Trumpcare by Niran al-Agba, a Physician in Washington State, states

"Our problems in health care have little to do with the patients or the physicians; rather it has to do with corruption of our administrators and nonessential healthcare players.   Beware of the snake oil salesmen touting their latest “solution” for the health care conundrum; instead, look to physicians with boots on the ground caring for real patients to provide tangible answers."

Strong words, but we agree whole heartedly.  What we do not agree with are some of the individual points in his manifesto, like 'stop penalizing physicians who do not use electronic health records.'  the benefits of EHRs are many and large.  Discussion of that topic is beyond the scope of this article, if you disagree you can go do the research yourself and write your own article.  What we need is a better EHR, one that doesn't interfere with care, or have an outrageous price tag.  Clearly, physicians can't design and develop software to document what they do every day.  If they could, they would have. 

Here is our conclusion based on the three reviewed articles: The ACA isn't going away, except by name.  We are going to continue to cover existing conditions and children who live at home and that is a good thing.  What we need to do is figure out how to take the business out of medicine, mostly, and to streamline processes and free the physician to  take care of patients with no other outside interference.  Sentia Health (the 'we' in this article) proposes an insurance company that provides its own EHR, free of charge, to document patient care in a way that is as fast as a physician can write, is dictation enabled, so the physician doesn't even have to write if she doesn't want to, and feeds directly to the insurance company, where we will electronically adjudicate the claim and pay for it in near real time.  This eliminates several cost centers plus the entirety of the insurance company.  We propose to provide this application as part of the insurance.  Our insurance will be billed at true, dead cost of the actual care, as determined by our actuaries, plus a small subscription fee of $10 per month.  By eliminating the cost of the EHR, the Medical Coder, the Billing Department and the whole insurance industry, we estimate that we can save the consumer about 1/3 of the cost of his or her insurance premiums.  That saves the population of these United States about one trillion dollars per year.  Go tell Trump that this is the way to save healthcare.  Get on the phone with Governor Christie and tell him to get this in front of Mr. Trump today.  This kind of innovation is the key to our future, just like it was 5 years or 5000 years ago.