Since Donald Trump was inaugurated as the President of the United States on January 20, 2017, he has made some decisions that have sparked controversy throughout the nation. Some of these decisions have proven to significantly impact the Healthcare field. Healthcare under Trump is gradually changing the industry, affecting both patients and professionals.
Healthcare Under Trump
Two of the most drastic actions of the Trump administration are the executive order for a travel ban and the proposal for healthcare reform. The reformed health care bill is still going through the legislative processes, but the travel ban has already affected healthcare in the nation.
The original executive order signed by Donald Trump, titled “Protecting the Nation From Foreign Terrorist Entry Into the United States,” set a temporary travel ban on 7 largely Muslim countries. Now, a revised order has been signed which removes Iraq from the list. When this order was signed, many people were forced out of the country; including healthcare professionals. Healthcare under Trump is significantly changing due to this travel ban.
Of physicians and surgeons in America, more than ¼ were born internationally. Since immigrant doctors play such a large role in the physician workforce, economists from Harvard and IMT investigated the level of contribution by these professionals. Results show that these immigrant physicians bring in 14 million doctor’s appointments annually. In addition, over 7,000 doctors that are actively practicing in the US were trained in countries listed on the travel ban.
Before this executive order, physician shortages were already in full swing and now it looks like the shortage will continue to worsen. There are current predictions that the United States will face a shortage of 46,100 to 90,400 physicians by the year 2025. Many hospitals were leaning on temporary physicians and immigrant doctors to aid in providing adequate patient care, but immigrant doctors are now scarce.
Taking effect on March 16, the revised order signed on March 6 restricts visas for citizens of Libya, Iran, Yemen, Somalia, Sudan, and Syria. Physicians from these countries have been providing medical care to 2.3 million patients in areas that cannot usually attract enough high-quality practitioners. With the travel ban keeping these professionals out, they are unable to work and provide care to patients.
The revised plan will keep the 90-day ban on travelers but will exempt permanent residents and current visa holders. This is certainly a step in the right direction for immigrant health providers, but healthcare under Trump is still struggling with the shortage of physicians.
Some Americans show favor to the Affordable Care Act (ACA), or Obamacare, while others have been waiting for a change. On March 6, House Republicans released their replacement plan that cited changes to the current ACA. Formally the American Health Care Act (AHCA), some call it “Trumpcare” or “Obamacare Lite.” The number of Americans with coverage under the plan and the overall cost is still unclear.
Here are some main points of the proposal:
- Replace income-based tax credits with refundable age-based tax credits
- Stop Medicaid expansion starting January 1, 2020, and convert to a per-capita system
- Eliminate requirements for individuals to have insurance and businesses offering coverage
- Expand allowable size of healthcare savings accounts
- Maintain coverage for people with pre-existing conditions and allow children to stay on their parents’ plans until age 26
- Allow insurers to charge higher premiums to those who do not maintain consistent coverage
Resistance to AHCA
The fate of this proposed bill is uncertain, but doctors, hospitals, and insurers are already showing opposition to the plan. James L. Madara, doctor and chief executive of the American Medical Association (AMA) wrote in a letter:
“We cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”
CEO of the American Hospital Association (AHA) Richard Pollock expressed concern of restructuring the Medicaid program:
“It will have the effect of making significant reductions in the program that provides services for our most vulnerable populations and already pays providers significantly less than the cost of providing care.”
Aside from these statements, some are in shock that hospital groups were showing such strong resistance to the proposed plan for healthcare under Trump. The GOP legislation plans to restore “the ACA’s cuts to ‘disproportionate share’ payments to hospitals that serve large numbers of uninsured patients.” The proposed changes could also affect the slow rise of the value-based healthcare model, but still with uncertainty.
With only a few days into the negotiation, individuals and businesses from both the right and left side have shown opposition. The AHCA and the new changes for healthcare under Trump are far from being finalized and may take longer than anticipated. President Trump is determined to have the bill approved and delivered quickly, but the reviewing bodies have some major concerns before that can happen.