Meaningful change will require all to rise above the partisanship and the rancor of the campaign to offer pragmatic solutions.
1. This was a change election.
Looking back, the results make more sense than could have been imagined in the final stretch. Voter turnout was the lowest in a presidential election since 1996. Only 57 percent of Americans voted, yet the resounding message was one of change.
2. The Republican trifecta still requires consensus building.
Trump’s victory was not a policy victory in the traditional sense – his policy proposals were not specific. With Republicans now in control of the White House and both houses of Congress, they have more power to advance their agenda, and yet they will still need to build consensus given procedural constraints, public impatience and the popular vote siding with Clinton. Meaningful change will require all to rise above the partisanship and the rancor of the campaign and offer pragmatic solutions.
3. There will be a sweeping pull-back of the Obama Administration’s regulatory policy.
It is clear that President-elect Trump wants to roll back Obama’s regulatory and executive actions. We expect his first executive order to be a moratorium on any new regulations and then a move to roll back regulations that could stifle innovation and growth. This could include the Medicare Part B drug demo, which is the mandatory experiment designed to evaluate ways to reduce expenditures on prescription drugs reimbursed through Medicare Part B. Cancer care providers and patients oppose this as it would dramatically reduce their reimbursement for oncology drugs. However, the appetite for payment and delivery reform is likely to continue as the push from fee-for- service to value-based payment has broad support from policymakers. Another potential pull back might be regulatory activity on interoperability of health IT through the Office of the National Coordinator of Health IT.
4. Affordable Care Act (ACA) changes are certain but are not so easy.
Many pillars of the ACA could be repealed using budget reconciliation, which only requires 50 votes. However, to avoid collateral political damage, Republicans must find consensus with the Democrats around a replacement strategy. The “repeal and replace” proponents espouse free market principles and consumer choice and yet are resolved to avoid major disruptions to consumers, insurers, providers and state governments.
5. The door is now open to tax and entitlement reform.
The first 100 days of any new Administration is a honeymoon period. Top priorities for the Trump Administration could also include tax reform, job creation, infrastructure repair, and entitlement spending reform. Proposals to address entitlement spending could include policies like Medicaid block grants or premium support in Medicare.
6. The States will continue to be on the frontlines of healthcare policy.
The States have been and will continue to be on the frontlines of implementing major reforms including the ACA, taxes, drug pricing, Medicaid expansion and solutions to combat the opioid abuse crisis.
This is part one of a three-part series. Stay tuned for health policy in a Trump Administration and the implications for health information technology.
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