With Donald Trump winning the U.S. presidential election and the Republicans maintaining control of both the U.S. House of Representatives and the Senate, the country will shift to the right and federal and state healthcare policy could change dramatically. What might this mean for radiology?
The Radiology Business Management Association (RBMA) Federal Affairs Committee, the American College of Radiology, and RADPAC (the radiology political action committee) will all be watching developments closely and will act to ensure the interests of radiologists and radiology practices are represented. The RBMA consulted with RADPAC Director Ted Burnes, a frequent speaker at RBMA conferences, and Liz Quam, chair of the RBMA's Federal Affairs Committee, to shed some light on what comes next.
Burnes believes Trump is a "wild card," in that he does not have a political background and therefore has no track record of past votes on healthcare policy issues. However, regardless of which approach Trump takes to fulfilling campaign promises such as the pledge to repeal and replace the Affordable Care Act (ACA), he will need to work with members of Congress and government agencies on legislation.
"A lot depends on who he'll appoint to key positions such as secretary of the Department of Health and Human Services, and what his temperament will be," Burnes said. "It also depends on who the speaker of the House will be. Rep. Paul Ryan may no longer hold this position."
In a normal election, a Republican Congress with a Republican president and the opportunity to appoint a Supreme Court justice that will make the court more conservative should be the answer to legislative gridlock. Yet the Republican Party is currently divided, and Trump could face some internal gridlock from Republicans who disagree with him, as well as filibusters from Senate Democrats. To avoid this, Republicans seen as more supportive of Trump could move into more influential positions in Congress.
"Rep. Tom Price supported Trump and I think he will have a lot of say, as will Rep. Renee Ellmers and Rep. Marsha Blackburn," Burnes said.
Ellmers lost her bid for re-election, but as a Trump supporter and a former nurse, she will likely be involved in the Trump healthcare changes in some way, Burnes added.
Quam agrees that it will be important to see if Ryan remains as speaker of the House.
"That said, the Ways and Means Committee likely won't change, and there are great members on it who understand healthcare," she said. "This includes the chair, Reps. Kevin Brady, Erik Paulsen, Pat Tiberi, and Dave Reichert."
Paulsen helped sponsor the clinical decision-support legislation that was incorporated into the Medicare Access and CHIP Reauthorization Act (MACRA). With a new administration coming in, it is possible that the U.S. Centers for Medicare and Medicaid Services may delay certain mandates created by MACRA, including the implementation of clinical decision support for radiology and the Merit-Based Incentive Payment System (MIPS) that will replace current disparate incentive programs such as incentives for meeting meaningful use requirements for electronic health records and the Physician Quality Reporting System (PQRS). Quam said early favorites to lead the Trump administration's healthcare team include Dr. Ben Carson, Gov. Rick Scott, and Newt Gingrich.
Burnes said he believes most healthcare legislation will continue to originate in Congress rather than the White House under Trump, which means that it will continue to be important to support congressional candidates. RADPAC-supported candidates who were elected for the next session of Congress include Sen. Roy Blunt, Sen. Richard Burr, Sen. Charles Schumer, Rep. John Shimkus, and Rep. Debbie Wasserman Schultz.
"Radiology will always be 'at risk,' but there will be some opportunities for us on some of our issues, we hope," he said.
Quam noted that dissatisfaction with rising healthcare premiums and narrow networks were part of the passion behind the Trump vote and affected races all the way down the ballot. That could make these issues of top concern in the next Congress.
"I am looking forward to some good work on the enrollment issues with the ACA by Senate Finance and House Ways and Means," she said.
State activity will grow in importance.
"With Republicans in control at the federal level, more decisions and less money will be pushed to the states, such as block grants for Medicaid," Quam says. "State action is going to be heavy and RBMA members will need to get involved in state policy."
One example is the issue of balance billing, where many state legislatures are moving to block providers from billing patients for the balance on bills when what the insurer pays is less than the cost of the procedure.
Finally, radiology practices could be affected by changes to laws governing business, including tax structures and overtime regulations, Burnes said.
James Hamilton is president of the RBMA Board of Directors and chief administrative officer of Medical Imaging Physicians in Dayton, OH.