AOPA’s Post-Election Analysis

In an election unprecedented in American history, Donald Trump defied the polls, conventional wisdom and notions of political correctness for a convincing win of the Presidency in the Electoral College, despite a roughly break even in the popular vote. What does it mean for orthotics and prosthetics, and health care more generally?

It is clear that the Affordable Care Act is likely to be repealed. There will need to be a replacement, and it may have several consistent features, for example, no exclusions for pre-existing conditions and maintaining kids on parents’ coverage until age 26. But expect the medical device excise tax to be history, as will major subsidies, and any tax on uninsureds. Medicaid will likely be addressed by block grants to states to use as they deem appropriate. Similarly, expect a move toward vouchers in Medicare. We’ll have a new CMS leadership, and large amounts set aside for innovations, ACOs and such may go away.

Beyond the Affordable Care Act, health care was not a major issue debated heavily in this election, so beyond these broad issues, what the Trump Administration’s health care will look like is not that clear. AOPA’s counsel, Alston & Bird, published a general overview, which included the following which we provide with attribution to our counsel’s authorship.

PRESIDENT-ELECT TRUMP’S HEALTH CARE PROPOSALS

The key issues include: health insurance coverage and costs; Medicaid; Medicare; opioids; prescription drugs; women’s reproductive health; mental health; and Zika funding. Almost any significant change below could face challenges in Congress. Below is an overview of President-Elect Trump’s proposals.

Donald Trump

Health insurance coverage and costs
* Repeal ACA and eliminate individual mandate
* Allow insurance to be sold across state lines
* Allow taxpayers to deduct entire health premium
* Allow people to enroll in tax-free Health Savings Accounts usable by all family members and inheritable without tax penalty
* Require price transparency from all health care providers to enable individuals to shop for the best prices on medical procedures
* Protect individuals from premium increases or exclusions due to the preexisting conditions
* Enforce immigration laws and restrict visas to reduce healthcare costs
* Work with states to establish high-risk pools to ensure access for individuals who have not maintained continuous coverage

Medicaid
* Move Medicaid to block grants for the states

Medicare
* Guarantee enrollees have an income-adjusted contribution toward a plan of their choice with catastrophic protection

Opioids
* Stop inflow of opioids
* Invest in heroin addiction treatment

Prescription drugs
* Allow drug importation
* Allow Medicare to negotiate drug prices
* Allow abortion only to save the life of the woman or in cases of rape and incest; limit access to later term abortions; make the Hyde amendment permanent

Women’s reproductive health
* Defund Planned Parenthood

Mental health
* Promote reform of mental health programs and institutions to assist families in helping loved ones

Zika funding
* Provide funding for Zika

In terms of specific impact on O&P, perhaps three comments are noteworthy: (1) the only Democratic candidate for the Senate who succeeded in defeating a seated Republican Senator is Senator-Elect Tammy Duckworth (D-IL), who as we all know is a double amputee Iraq war hero who has been a major champion for O&P; (2) President-Elect Trump has emphasized a commitment to improve care for Vets, and our guess is that could well improve the role for private sector contractors and lessen movement toward more O&P care by VA-employee prosthetists/orthotists; and (3) the threat for competitive bidding being errantly applied to O&P, and the strong reliance on data driven decisions and emphasis on quality and cost effectiveness of care are concepts largely embraced on both sides of the aisle, so we can expect the efforts as well as some battles around these to continue. There will almost certainly be a lame duck session of the old Congress, likely a short one with many remaining issues simply pushed forward to the new President and Congress. However, AOPA has laid a good bi-partisan foundation for possible action on issues around both S.829/H.R. 1530, the Medicare O&P Improvements Act, and the proposed LCD during that lame duck session, the timing and duration of the session permitting.

As with any new administration, it will take time for Presidential cabinet and agency appointments to play out, as well as for new health-related Committees in the House and Senate to be settled-in short, it will take a while to determine who key players in the Executive branch and in the 115^th Congress will be. AOPA will continue to be a strong advocate for O&P professionals and their patients. Our 2017 AOPA Policy Forum is slated for May 2017, with tentative, but most likely dates being May 23-25. 2017 promises to usher in a brave new world in Washington-mark your calendars for the AOPA Policy Forum, and plan to be part of it!