This article is more than 5 years old. Information may no longer be current.
Ophthalmology reacts to possible ACA, FDA changes under Trump
Click Here to Manage Email Alerts
The shift to a Trump administration could mean several health insurance changes and the strengthening of Medicaid.
Several ophthalmic sources are speculating on how the transition to a President-elect Donald Trump administration and a Republican-led Senate and House could affect health care and ophthalmology throughout the country.
If Hillary Clinton had won the election, the country may have seen a transition to a single-payer insurance system. Trump likely will not entertain this as a possibility during his presidential term and may seek to make several changes to the Patient Protection and Affordable Care Act, OSN Chief Medical Editor Richard L. Lindstrom, MD, told Healio.com/OSN.
“The ACA will not be repealed; it will be emasculated. What’s going to go away is the controversial — possibly according to some the unconstitutional — part of it: the individual mandate where everyone is required by law to have health insurance and if they don’t buy health insurance they will be penalized. The Supreme Court defined that as a tax and it was legal, but many people think it’s unconstitutional,” he said.
Change in the ACA
The repeal of the individual mandate in which all citizens are required by law to have health care insurance may even happen during the first 100 days of Trump’s presidency, Lindstrom said.
The number of uninsured in the country has gone down since the ACA’s inception in 2010. However, the number of uninsured will likely increase if these changes are made, he said.
Republicans also tend to put more power into states’ rights, and the country could see a “strengthening” of Medicaid during Trump’s presidency.
“We can all remember back 5 to 10 years ago what it was like to operate under Medicaid in our particular states. In some states, and I guess Minnesota where I practice is one of them, Medicaid worked very well. There was a very low number of uninsured, it’s not bad in Minnesota, but there are some states where Medicaid was vastly underfunded and worked very poorly. The individual doctors know what that was like, and they’ll probably get it again. Having a Medicaid patient will be, in some states, like philanthropy or altruism. If you want to take care of them, you’ll do it out of the goodness of your heart because you probably won’t get compensated or reimbursed at all,” Lindstrom said.
First health nomination
On Nov. 29, Trump made a nomination to the U.S. Department of Health and Human Services that may have implications for how he handles health care during his tenure as president.
Trump nominated Rep. Tom Price, MD, R-Ga., to lead the U.S. Department of Health and Human Services, a move that was endorsed on the same day by David W. Parke II, MD, CEO of the American Academy of Ophthalmology.
“We can think of no better voice to lead our nation’s critical health care programs, including Medicare, the Food and Drug Administration and the National Institutes of Health. We’ve worked side-by-side with Rep. Price on numerous issues since he took office in 2005, and find him to be creative, thoughtful and committed to the idea that quality patient care must govern all policies that impact our nation’s health care system,” Parke said in an AAO press release.
Trump said during his campaign that he hoped to “modernize Medicare” if elected to the presidency, which could possibly mean a funding cap the government provides to Medicare, Cathy G. Cohen, MHSA, CAE, vice president, governmental affairs, American Academy of Ophthalmology, told Healio.com/OSN.
“Ophthalmology is very Medicare focused, so what would this mean? All our research shows, that if you look at what the Republican House and Senate have meant by that, Paul Ryan has had an agenda since 2011 to try and bring about a voucher program, capping the amount that the government spends and then letting the beneficiary shop. We have some concerns about that. Obviously we don’t know about our patients being able to find coverage for these prices,” she said.
ASC reimbursements
One factor Trump should examine is the disparity of reimbursements between hospital ASCs and standalone ASCs, OSN Cornea/External Disease Board Member Eric D. Donnenfeld, MD, told Healio.com/OSN.
Hospital ASCs are reimbursed at twice the rate of standalone ASCs, he said.
“With that in mind, I think there are a few disparities that exist in ophthalmology that are inappropriate and ... I see the disparity in reimbursement between ambulatory surgical centers and hospital ASCs as being completely inappropriate. There are billions of dollars to be saved in the medical system there. I would hope that he would recognize and speak with CMS about the need to establish a reimbursement strategy that aligns the ASCs and hospitals in a way that is fair and balanced, so that hospitals aren’t reimbursed essentially twice what ASCs are reimbursed for providing the same service,” he said.
This is a basic issue that any capitalist would look at and realize is an incorrect part of the health care system. By realigning reimbursement, Trump could save health care billions of dollars without affecting patient care, Donnenfeld said.
Potential FDA changes
The new administration could also bring about regulatory changes in both the device industry and the FDA, according to AdvaMed President and CEO Scott Whitaker.
“AdvaMed congratulates Donald J. Trump on being elected the 45th President of the United States. In the coming year, policymakers will be dealing with a number of important policy issues, including authorization of the latest Medical Device User Fee agreement to continue improving the FDA regulatory process, repeal of the medical device tax, and ensuring that the coverage process allows patient access to the latest innovations. These have been and will always be bipartisan issues. The medical technology community stands ready to work with President Trump, his administration and the new Congress on pro-innovation policy solutions to address the health care challenges facing the country and to ensure all Americans have timely access to the latest medical technologies, devices and diagnostics,” Whitaker said in an AdvaMed statement.
Trump’s support of the free market would perhaps lend itself to streamlining the FDA’s ability to expedite new technologies to the U.S. market, ophthalmologists and patients, Donnenfeld said.
If Trump moved the FDA approval process to be more like the European model, it would put the responsibility of proving device efficacy into the doctor’s hands instead of the government, he said.
“I think he could do both, but I think the device market would be a very simple way to do this. I think devices would be a very simple way of looking at this. In the European model of approval, the government is responsible for testing the product to see if it is safe, and the doctor is responsible for deciding whether it is efficacious. The government is asked to do both in the U.S. Putting it in the hands of the physicians and making sure the technology if efficacious is more important and would reduce the burden of large, expensive FDA trials, with the FDA being responsible for making sure the technologies are safe and not doing damage,” he said.
Pharma changes
Trump’s free market support may also open the country to bringing in cheaper drugs or pharmaceuticals from Canada if it proves to be a cheaper option, Lindstrom said.
People seem to be fed up with big pharma, he said, and the new administration may listen to their concerns.
“It seems, if you look at the stock market, people are concerned about big pharma, even in the face of arguably a pro-business Republican situation — the whole population is a little bit upset with the way the prescription drug thing is going. I do see some pressure on the idea of taking old drugs and jacking up the prices. I don’t think that’s going to happen, but I think there will be a move to make biosimilars and generics more readily available,” he said.
Even with the potential changes to the ophthalmology landscape, Lindstrom stressed that it will likely not be much different than when Republicans were in power at the White House before.
“Most ophthalmologists should just try to remember back to what it was like 10 years ago, and it will likely be similar,” he said. – by Robert Linnehan
References:
American Academy of Ophthalmology statement on the nomination of Rep. Tom Price, M.D., to lead U.S. Department of Health and Human Services. Published Nov. 29, 2016. Accessed Nov. 29, 2016.
For more information:
Cathy G. Cohen, MHSA, CAE, can be reached at American Academy of Ophthalmology, 20 F. St. NW, Suite 400, Washington, D.C. 20001-6701; email: cgcohen@aao.org.
Eric D. Donnenfeld, MD, can be reached at Ophthalmic Consultants of Long Island, 711 Stewart Ave., Suite 160, Garden City, NY 11530; email: ericdonnenfeld@gmail.com.
Richard L. Lindstrom, MD, can be reached at Minnesota Eye Consultants, 9801 Dupont Ave. S., Suite 200, Bloomington, MN 55431; email: rllindstrom@mneye.com.
Disclosures: Cohen, Donnenfeld and Lindstrom report no relevant financial disclosures.