What Could the Upcoming Midterm Elections Mean for Physicians and Healthcare?

Leigh Page

Disclosures

October 09, 2018

In This Article

Could More Regulations Be in Our Future?

Even if Congress descended into total gridlock, the Trump administration has the option of making policy changes on its own in many areas. Unless Congress acts, "I do believe that the only changes we will see will be through executive order," Campbell says.

The administration has been very busy on the regulatory front. In July, it released a final rule that could significantly undermine the ACA by allowing people to buy health insurance that doesn't meet the ACA's minimum coverage requirements, such as the protection for preexisting conditions.

The rule would take short-term insurance, which the ACA has allowed for up to 3 months of coverage, and extend it to almost 3 years. The administration predicts that the new policies, which could be available as early as October, would cut premiums in half and would initially be sold to 600,000 people, rising to 1.6 million by 2022.[10]

Meanwhile, the administration is trying to address doctors' concerns with its new "Patients Over Paperwork" initiative, run by the Centers for Medicare & Medicaid Services (CMS). CMS officials have been meeting with doctors across the country for many months to get input on it.

In July, CMS released proposed rules that would reduce documentation requirements basically by collapsing the five evaluation and management codes into two codes, of which only one would be used by physicians. Reporting of data would be significantly cut back because CMS would no longer need to distinguish the different payment levels.

Physicians with a lot of high-level codes are concerned that their reimbursements would plummet. But CMS contends that these losses would be more than matched by reduced expenses from not having to report the data.[11]

"We'll have to see whether the Trump administration actually succeeds in reversing Obama-era regulations of physicians," Campbell says.

Many doctors are resisting the proposed change, and CMS may ultimately decide to back off. This would be a setback for the Trump administration's ability to act alone without Congress.

But Pearl believes the CMS initiative is "basically a good thing" for doctors. "It's a big issue for doctors," he says. "It takes a huge amount of time to fulfill documentation requirements."

In the battle to reduce doctors' documentation burdens, such changes just nibble around the edges, Pearl maintains. "The best way to reduce documentation is to shift Medicare from fee for service to capitation," he says. But that's a change that would take Congressional action.

Private Industry to the Rescue?

With many signs pointing to a logjam on health policy after the midterms, Pearl thinks the best chance to fixing the healthcare system lies with private payers and employers who pay for health insurance.

For the healthcare system to get fixed, "it needs to go through disruptive change, but government rarely undertakes disruptive change," he says. "It will be up to large businesses, particularly those that are self-funded, to lead the effort."

He pointed to plans by Jeff Bezos of Amazon, Warren Buffett of Berkshire Hathaway, and Jamie Dimon of JPMorgan Chase to form a healthcare company that would work directly with doctors and hospitals. The effort is still in planning stages, but "it may be just the thing to start this process," he says.

Meanwhile, healthcare policymaking may have to put up with a hyperpartisan, gridlocked federal government—to the detriment of patients, doctors, and any plans that could be made to improve the system.

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