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Trumpcare and its effect on MDs

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  • Trumpcare and its effect on MDs

    Without getting into the actual politics, I do not see how physicians will benefit from changes proposed by Trump to the ACA. Allowing insurance to compete across state lines sounds like a good way to have more leverage in negotiations with providers (not that most of us have much to begin with). Doing away with the Obamacare exchanges and additional Medicaid assistance will increase the number of uninsured people, for whom we will have the opportunity to provide (more) free service.

    If this all comes to pass, weaker physician practices and health care organizations will struggle even more with lower revenues and will be forced into bigger entities, where they will have less say and control and risk losing their culture.

    Finally, the MACRA, MIPS, HiTech, Meaningful Use, and all of the regulatory nonsense likely moves forward, unabated. These are secular trends and programs, administered by bureaucrats, and probably survive no matter which party is running the government. Pretty sad all around.

    Does anyone read this any other way?

    (On the flip side, if taxes are cut, we might benefit by paying lower taxes on this lower income, perhaps a silver lining...)

  • #2

    Does anyone read this any other way?

    Yes. Your argument is interesting but, with all due respect, I regard it as I do all prognostications - you may be right and you may be wrong. If you are driving at 90 mph toward the Grand Canyon and you realize you will go off the edge in 3 hours if you don't adjust course, do you throw up your hands and start praying or do you adjust course?

    Just because you do not see a solution at this point in time does not mean that one does not or cannot exist.
    Working to protect good doctors from bad advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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    • #3
      Sadly, my impression is closer to VagabondMD's. Congressional Republicans already passed a partial Obamacare repeal of individual mandate and ACA exchange subsidies. I have no doubt they will pass it again in January. I doubt Trump cares either way enough to veto. All of the regulations, "alternative payment models" etc cannot be repealed unless Senate Democrats go along. MACRA is completely separate legislation and is not going anywhere. So we'll be back to where we were pre-2008 in terms of uninsured patients, except with a bunch of extra regulations.

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      • #4
        Any increase in uninsured patients is going to be bad for (most) physicians and hospitals (probably especially hospitals).

        To quote trump:

        “By following free market principles and working together to create sound public policy that will broaden health care access, make health care more affordable and improve the quality of the care available to all Americans.”

        Free market is all well and good but the fact is healthcare and health insurance is not a free market.  If they drop the individual mandate then premiums will only rise even faster as the healthy folks remain uninsured, which has been the big issue with obamacare plans so far.  Selling insurance across state lines will only do so much, the large insurers are all merging anyway.  He has proposed making premiums tax deductible, while the current subsidies are a tax credit

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        • #5




          Does anyone read this any other way?

          Yes. Your argument is interesting but, with all due respect, I regard it as I do all prognostications – you may be right and you may be wrong. If you are driving at 90 mph toward the Grand Canyon and you realize you will go off the edge in 3 hours if you don’t adjust course, do you throw up your hands and start praying or do you adjust course?

          Just because you do not see a solution at this point in time does not mean that one does not or cannot exist.
          Click to expand...


           

          So, you think the pols and wonks are keeping it a secret? ?

          Oh, after I posted this, I listened to Diane Rehm's show today, and the three health policy experts were largely of the same opinion regarding what was coming down the line. What they did indicate is that the changes will probably gradual, over the next couple years.

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          • #6




            Any increase in uninsured patients is going to be bad for (most) physicians and hospitals (probably especially hospitals).

            To quote trump:

            “By following free market principles and working together to create sound public policy that will broaden health care access, make health care more affordable and improve the quality of the care available to all Americans.”

            Free market is all well and good but the fact is healthcare and health insurance is not a free market.  If they drop the individual mandate then premiums will only rise even faster as the healthy folks remain uninsured, which has been the big issue with obamacare plans so far.  Selling insurance across state lines will only do so much, the large insurers are all merging anyway.  He has proposed making premiums tax deductible, while the current subsidies are a tax credit
            Click to expand...


            Yes, he is already going down the same rabbit hole as all who have come before.

            Fast, cheap, high quality--you get to pick two. The "triple aim" is a joke.

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            • #7
              I must admit that Obamacare increased my income primarily because of less "no pays" in the ER.  Obviously, I paid more in taxes.  I never ran the numbers to see how it washed out.  My biggest concern with any New New Health Care Law is that it may be harder to self-insure with health insurance;  this is a major facet of The Plan as I cut down/out of medicine 20 years before Medicare age.  Bottom line--who knows?!

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              • #8


                So, you think the pols and wonks are keeping it a secret? Oh, after I posted this, I listened to Diane Rehm’s show today, and the three health policy experts were largely of the same opinion regarding what was coming down the line. What they did indicate is that the changes will probably gradual, over the next couple years.
                Click to expand...


                Of course not. I just believe that they may or may not be right and very well may be wrong, same as the political wonks didn't know how the election would turn out. Too many cooks in the kitchen to know how the soup will taste at this point.
                Working to protect good doctors from bad advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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                • #9
                  I know it has been discussed briefly either here or on SDN, but any thoughts of whether a 15% corporate tax rate (if this ever even happened to begin with) proposed by Trump would possibly be applicable to certain 1099 employees? Just curious.....

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                  • #10
                    Did you read my article (also on this thread)? It answers your question as best I can for now until we get more clarification.
                    Working to protect good doctors from bad advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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