With the election less than 2 weeks away, many doctors are wondering just that!
With declining compensation and skyrocketing overhead costs, many physicians are contemplating the future of their practices and which candidate will enable them to function the best for their patients and survive.
While Hillary Clinton, the former Secretary of State vows to further advance Obamacare, provide healthcare for immigrants and deal with escalating drug prices, Donald Trump wants to abandon Obamacare, import medications and sell health insurance coverage across state lines to foster more competition, thereby lowering the premium cost.
Almost ten percent of Americans still lack any healthcare coverage. Clinton wants more Americans covered by the ACA. Approximately 20 million people gained health insurance through the exchanges or Medicaid expansion. A national public Clinton states she will work with every governor to enact state-based public option insurance plans, an approach that will not require Congressional approval. She wants to hire more patient navigators and conduct more outreach to encourage enrollment.
According to Dr. Judy Feder, professor at Georgetown University’s McCourt School of Public Policy:
“If you have only one insurer, there’s a concern that there is not enough competition to keep premiums affordable. Having a public plan would ensure that there is a viable competitor in every marketplace.”
Robert Doherty, senior vice president for governmental affairs and public policy with the American College of Physicians (ACP), feels that a public option could be good for physicians. Payment that is at least on par with Medicare or some private plans would encourage more physician participation, according to Doherty.
Clinton also wants to expand Medicare by allowing people to buy into the program starting at age 55. A recent study by Avalere, a Washington, D.C.-based healthcare consultancy, reported that nearly 13 million Americans over age 50 who are currently uninsured or have individual coverage purchased through the private market may be eligible to buy into Medicare.
She believes it would benefit physicians even if reimbursements are lower than those of commercial plans, because it will allow more people to get care and generate more revenue for practices, assuming payment rates are at least on par with current Medicare levels. There are problems with making Medicare available in the exchanges A glaring problem arises here though because the Medicare benefit package is less generous than what the ACA requires. Details on what coverage would be included are still vague.
Clinton also proposes to double funding for primary care over the next decade by expanding the system of Federally Qualified Health Centers (FQHCs), safety-net outpatient clinics in medically underserved urban and rural communities. She would extend current FQHC funding under the Affordable Care Act and expand it by $40 billion over ten years.
Trump’s healthcare promises to repeal and replace the ACA in favor of “free-market reforms.” He would do away with the mandate that everyone have healthcare insurance, and allow insurers to sell products across state lines. Analysts disagree as to whether complete repeal is a necessary step to correcting frustrating flaws in Obamacare.
David Bowen, PhD, global lead in health for Hill+Knowlton in New York, feels that repealing the ACA will hurt the poorest and sickest Americans. “Removing [the ACA] and replacing it with vague promises where the numbers don’t add up would be catastrophic for Americans coast to coast,” he says. He cites the non-partisan fiscal analysis group The Committee for a Responsible Federal Budget’s assessment of Trump’s seven-point healthcare plan, which found that the plan would cost $550 billion over a decade.
Gerald Kominski, PhD, professor of health policy and management at the UCLA Fielding School of Public Health, also worries that repeal would leave the country with a host of problems. “It means we roll back the clock to a marketplace where people could be denied insurance, where insurers could offer a whole variety of products and weren’t held to any real standards,” he says. He fears that many of the 20 million people who receive coverage under the ACA would “rejoin the ranks of the uninsured.” This doesn’t bode well for physicians, either, he says, since they “would now be dealing with patients who were newly uninsured,” and who may struggle to pay for their care.
Not all analysts are pessimistic about the impact of repealing the ACA, however. says
Sally Pipes, president and chief executive officer of healthcare policy at the Pacific Research Institute, and a former health adviser to Rudy Giuliani, states that “I think there’s no question that Obamacare is in trouble.” She points to large insurers like Humana and UnitedHealthcare exiting exchanges, due to the losses they are sustaining on their exchange plans. “The exchanges reduce competition,” she says.
Pipes sees Aetna’s attempts to acquire Humana and Anthem’s pending purchase of Cigna as ominous. The health insurance industry is attempting to consolidate “in order to cope with Obamacare’s heavy regulatory burden and heavy losses on their exchange plans,” Pipes says. This is bad for physicians, because large insurers could dictate lower reimbursement rates for doctors. Because of this, Pipes supports Trump’s repeal goals, though she “wants to see more bones” on his plan. She suggests a vision in which one person could get a plan, “that covers alcohol rehabilitation and in vitro fertilization,” for example, while another person would have entirely different coverage.
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