What should and will likely be maintained, both Glied and Dr. Lenchus say, are changes to the delivery of and payment models for healthcare. Medicine has been moving toward higher-quality care and away from fee-for-service for years, and “everybody would agree that’s probably not the correct incentive in medicine,” Dr. Lenchus adds.
With a shift toward more state-level responsibility, Glied says the GOP may also encourage states to innovate around healthcare so long as costs are well-managed. Incidentally, under the ACA, 2017 marks the start of Section 1332 waivers, which provide structure for states to develop their own approaches to healthcare.
However, “changes in the practice of medicine are not going to come out of government,” Glied says. “They’re going to come out of improvements in health IT technology, through changes in the use of midlevel professionals who eventually slide into practice as new residents come out of training.”
Though the election all but guaranteed continued uncertainty moving forward, Dr. Lenchus does not believe it will mean much change in his day-to-day practice of medicine. His safety-net hospital, however, may see an uptick in uncompensated care once more while also trying to survive with cuts to reimbursement made through the ACA.
““I don’t think anyone’s getting the hospitals back that money,” Glied says.
The experts say Congress has its work cut out, particularly as it shapes the future of healthcare in the U.S. based on conservative principles while also taking into account the potential number of newly uninsured patients upon repeal of the ACA.
“The problem is people don’t have coverage because they don’t have money. … Healthcare is expensive, and people are poor,” says Glied. “There is a lots of space to move left in healthcare. It’s hard to see where it can move right.”
Kelly April Tyrrell is a freelance writer in Madison, Wis.
- President Elect Donald J. Trump. https://www.greatagain.gov/policy/healthcare.html
Accessed November 22, 2016
- Budgetary and economic effects of repealing the Affordable Care Act. Congressional Budget Office website. Accessed November 15, 2016.