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What's Ahead for Health Care in the Trump Administration

ACP leaders vow to stay firm but flexible in advocating for physicians and patients

The presidential election results could barely have been more unpredictable, but the response from the American College of Physicians has been what its members have come to expect: ACP will continue its unceasing advocacy for the needs of patients and their physicians.

"Our work goes on no matter who is in the White House," said Bob Doherty, ACP's senior vice president for governmental affairs and public policy. "Like everybody else, we're going through an assessment of our advocacy priorities, recognizing there will be some major challenges to the Affordable Care Act, climate change and other issues."

However, ACP doesn't plan to spend all of its time fighting. "We're also going into this saying we want to achieve bipartisan progress in areas the parties agree on," Doherty said, such as opioid addiction, mental health care and telemedicine.

Front and center, though, is the fate of the ACA. Republicans, including the president-elect, are committed to repealing it. But, as The Hill reports, "congressional Republicans face internal divisions over how far to go ... without disrupting the lives of millions of Americans."

Indeed, GOP members of Congress have expressed concern about hurting those who recently got insurance through efforts like Medicaid expansion. "Clearly we don't want to do any harm to people who are in the system now. We want to be mindful of that," Sen. Roger Wicker, a Mississippi Republican, told The Hill.

President-elect Donald Trump, in a "60 Minutes" interview, said that he hopes to retain guaranteed coverage for pre-existing conditions and the ability to keep children on their parents' policies until age 26 -- two of the ACA's more popular provisions.

As health care experts have noted, guaranteed coverage hinges on the insurance mandate and subsidies for people with lower incomes. "Trump's proposed replacements -- making individual market premiums tax deductible and allowing insurers to sell policies across state lines -- would only marginally reduce these coverage losses," Dr. David Blumenthal, president of the Commonwealth Fund, told "Pulse," a daily tip sheet on health published by Politico.

In fact, Los Angeles Times columnist Michael Hiltzik wrote that that insurers can already sell their products for individuals across state lines in certain situations -- but they just don't want to. "Consumers aren't clamoring for them, insurers aren't interested in them, doctors and hospitals don't care and state regulators aren't inclined to cede their oversight to interlopers from somewhere else," Hiltzik wrote.

Amid all of this, ACP remains committed to standing firm while also being flexible, Doherty said.

"We'll be open to conservative ideas about changes to the law," he said, "but the bottom line is that we're committed to universal coverage, to ensure that those who are covered don't lose their insurance. That's the threshold issue for us: Will these policies increase or decrease the number of people with access to health care coverage?"

The ACP is monitoring election-related issues beyond the ACA as well. As Dr. Nitin Damle, ACP's president, noted in a letter to members, the College is hearing from international ACP members and immigrants to the United States who are worried about potential changes in the nation's immigration policies.

ACP is also concerned that the new presidential administration will reverse progress that's been made on climate change and common-sense firearm regulations.

But as Damle noted in his letter, ACP is committed to engaging "in a constructive and bipartisan way with President-elect Trump and his administration, and with Congress, to achieve bipartisan progress on the College's policy objectives. Our hope is to find common ground."

Efforts where bipartisan reform can be accomplished, he said, including fighting the opioid epidemic, improving access to mental health care, expanding chronic disease care and building telehealth services. There's also potential for bipartisan support for strengthening graduate medical education funding and primary care training programs and improving payment models under the Medicare Access and CHIP Reauthorization Act (MACRA). Other areas that hold promise for bipartisan reform, Damle said, include quality measurement, prescription drug costs, the medical liability system and the reduction of administrative burdens on physicians.

As Doherty noted, "we're not partisan -- we'll work with whomever voters put into office."

Still, he said, "the greater the challenges, the more important it is that we be organized and committed."

Members are crucial to these efforts. As Dr. Damle put it, "if you are a U.S. member of the College, become a grassroots activist for internal medicine by joining our Advocates for Internal Medicine Network (AIMn). As a member of AIMn, you will get timely and concise updates on key developments in Congress, and what you can do to help us achieve our advocacy priorities in this new environment."

More Information

Members can sign up for the Advocates for Internal Medicine Network on the ACP website.

Read more about the impact of the election in Bob Doherty's "Health Cents" blog in the Philadelphia Inquirer.

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