14 healthcare thought leaders on President Trump's executive order on the ACA

President Donald Trump signed an executive order on Jan. 20 to lessen the economic burden of the ACA.

Fourteen industry thought leaders and executives discuss the impact on physicians, hospitals and medtech.

Laura Wooster. Interim Senior Vice President of Public Policy, American Osteopathic Association (Chicago). "President Trump's executive order opens the door to move healthcare reform beyond the path Congress started with its budget votes. It is now up to policymakers to decide how they want to move forward, and when we might see concrete proposals.

As proponents of patient-centered care, the American Osteopathic Association's priority is to ensure future policy puts patients in a better situation than they are today. Our physicians, who practice in every medical specialty and region in this nation, will be looking closely at proposed policies, specifically in terms of patient access to high quality, affordable care.

The osteopathic philosophy of medicine focuses on the needs of the whole person. The AOA strongly supports delivery models that emphasize prevention and coordinated care with primary care as a cornerstone. We hope lawmakers continue the transformation toward a value-based health care system that benefits patients, and broadens opportunities for physicians."

Joel Shalowitz, MD. Professor of Preventive Medicine at Feinberg School of Medicine Professor of Executive Education Kellogg School of Management, Northwestern University (Evanston, Ill.). "I view the executive order as more of a general policy statement than an instrument of actual change. Congressional action is required to repeal or amend the ACA and the regulations related to it require a statutory comment period. It is a 'shot over the bow' that says the new president is serious about his repeal agenda.

Two important issues are noteworthy, however. First, the real financial hardship people face is not the penalties assessed for lack of insurance, but the high deductibles, which are often far more than those penalties. Second, the action that would be most disruptive to the ACA would be a Presidential order for the Justice Department to withdraw its appeal in: House of Representatives v. Burwell. In that action, the House prevailed in the lower court as it challenged the Executive Branch's ability to subsidize insurance premiums without Congressional appropriation. If the court decision stands, the exchanges could be destabilized as more Americans would have to pay the full cost of their insurance."

John Greenbaum. National Practice Leader of Employee Benefits of Risk Strategies Company (Boston). "The executive order's references to 'makers of medical devices, products or medications' could lead to the suspension of the medical device tax and the tax on the pharmaceutical industry. While this could prove a windfall for these two groups it would further weaken the financial underpinnings of the structure and lead more quickly to its collapse."

Julie Scott Allen, Senior Vice President, District Policy Group at Drinker Biddle (Washington, D.C.). "For medical device and pharmaceutical companies, the executive order offers a promise to adjust regulations that impose 'fiscal burden' on devices, products, or medications. Full repeal of the medical device tax is certainly one of the most significant focuses of the device industry. While repeal requires Congress to act, the Executive Order infers support for the tax’s repeal."

Dave Dyell, CEO of Jellyfish Health (Panama City, Fla.). "Although the language is broad, President Trump’s executive order seems aimed to open the market up to more options for healthcare consumers, and not just for insurance. Look at section four's reference to more interstate commerce of healthcare services. Really, it's time to double down on improving the patient experience, or local healthcare consumers could be lost to national telehealth chains. The window to differentiate is short, too. Yes, you need an overall patient experience strategy, but it needs at least one tactic that immediately creates a better experience — like mobile apps that make it easy for patients to find and schedule care in their area, and even make anywhere the waiting room for them."

Dr. Stuart Hochron. Chief Medical Officer and founder of Uniphy Health (Minneapolis). "Much of what this bill outlines is actually quite laudable and not a surprise; it reflects the core of the Republican approach to healthcare and takes advantage of what we've learned in the past eight years. The proposed centrality of the HSA creates a huge opportunity to unleash innovation. Consumers will need digital tools to help them make decisions about how and where to spend the healthcare dollars they control. There will be demand for powerful comparison features allowing consumers to look at service providers by price, availability, convenience, reliability. I believe this could be the dawn of the 'Amazon of Health': A seamless and personalized user experience where the next generation of intelligent applications helps consumers quickly and efficiently make smart buying decisions and healthcare systems can deliver added value and earn consumer loyalty."

David Lareau. CEO of Medicomp Systems (Chantilly, Va.). "Regardless of what the new administration decides to do about the ACA, the era of value-based (or outcomes-based) reimbursement is going to stay with us. As the population ages, it will be more important than ever for enterprises to make better use of clinical data at the point of care to improve outcomes and control costs."

Jon Elwell, CEO Kno2. "Regardless of administration (Trump, Obama or otherwise), healthcare’s cost and its affordability will continue to be a core focus. The United States cannot continue to fund Medicare at the rate in which it is growing. With this in mind, healthcare stakeholders will need to work even more closely – leveraging interoperable technologies -- to lower healthcare costs, drive better care coordination and improve patient outcomes. This should – and will – happen, regardless of the administration. It's an economic imperative."

Jon Pearce, CEO for Zipnosis (Minneapolis). "The short answer is that it's unclear how this will directly impact physicians in the near term. I believe the shift from fee-for-service into value-based care is inevitable, even with Trump's executive order, so providers will continue to move in this direction. Innovative forms of healthcare delivery, such as virtual care, continue to be the future in a value-based care environment."

Ruchi Dhami. Director of Research at Recovery Brands (San Diego). "There is a large subset of the healthcare provider population, and consumers they serve, that will be negatively impacted by the recent waiving of ACA enforcement. The community I am speaking of are the ones fighting hard to combat overdoses and lead millions Americans into a life of recovery; they are addiction treatment providers.

Under the ACA, mental health and addiction treatment are considered essential benefits. This was a huge step forward, and one that benefited providers and consumers alike. In fact, more than 50 percent of Americans rely on some form of insurance to receive addiction treatment. However, without current ACA enforcement, insurers may neglect to cover treatment of these diseases to the same degree that they cover other chronic illnesses.

Historically speaking, this isn't a far-fetched concept as tensions between treatment providers and insurers have already been heightened. Oftentimes, treatment providers are forced to spend time navigating benefits and fighting insurance wars just to ensure individuals can receive the proper quality of care. Our country is in the midst of an opioid crisis, so for the benefit of consumers, I hope for a quick resolution — one that upholds these critical, essential benefits."

Elise Schuller Barajas, Board Certified Health Law attorney at Gray Reed & McGraw (Dallas). "Whether President Trump's executive order related to the Affordable Care Act serves any 'functional purpose' really depends on the intended function. The intent is most likely to send the message that President Trump is following through on his promise to do away with the ACA. It additionally sends a signal to the various government departments that the Trump administration is putting an end to strict ACA enforcement in favor of future regulations that will eventually eliminate it – which regulations will still need to go through the administrative process, including the publication of proposed regulations and comment period before finalization."

James Roosevelt Jr. Verrill Dana Attorney (Boston) and Former President and CEO of Tufts Health Plan. "President Trump's executive order appears to be intended to fulfill his campaign pledge to repeal the Affordable Care Act on day one of his presidency. Because of its broad and unspecific nature, the order creates great uncertainty for all segments of healthcare. It makes clear that further implementation of the Act beyond its current regulatory framework is halted but it does not clarify what, if any, provisions will not be enforced or reversed."

Sam Halabi. Associate Professor of Law at the University of Missouri (Columbia). "The fundamental bargain of the ACA was that insurers would take on more sick people in exchange for more healthy people enrolling. If only one half of the bargain is kept, no insurer would offer a policy without some kind of legal compulsion or financial incentive in its place."

Robert M. Goldberg, PhD. Vice President and Co-founder of the Center for Medicine in the Public Interest (New York City). "It's hard to speculate at this point. But it's fair to say that the executive order has limited impact on coverage reimbursement or access."


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