2016 Election Reflections: Summary and Potential Impact on ACG Members Moving Forward

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    Whitfield L. Knapple, MD, FACG Chair, ACG National Affairs

    Whitfield L. Knapple, MD, FACG
    Chair, ACG National Affairs

    The 2016 elections have come and gone.  Donald Trump will be the next United States President and Republicans will maintain control over the U.S. House and Senate.  What is the potential impact to ACG members?  Here are some items ACG is watching:

    Lame Duck Congress: Before we get into next year, let’s not forget that Congress will come back to work in 2016.  For how long and what they do remains unclear.  However, ACG’s meetings with key Hill staff have suggested that health care related issues such as the “21st century cures” bill (legislation designed to improve investment in technology and medicine) as well as certain year-end Medicare extensions will be in play.  ACG is also actively engaging Congress to pass legislation that removes barriers to colorectal cancer screening (2 bills), expanding treatment for hepatitis C and obesity, as well as bills designed to reduce regulatory burdens for GI practices.

    The Affordable Care Act: President-elect Trump and Republican leaders in Congress have already stated their intention to repeal the Affordable Care Act (ACA).  Pundits and policymakers expect changes to the ACA, but it remains to be seen whether Republicans will keep some of the provisions authorized in the ACA.  Republicans did maintain majority in the U.S. Senate, but Democrats gained two seats (IL and NH), meaning it will be difficult.  The Senate will have to repeal the ACA through a process called “budget reconciliation,” which allows the Senate to bypass the traditional process of needing 60 votes to stop the debate and allow a bill to proceed to a final vote.  This may be the vehicle to overturn the provisions on taxes and penalties for individuals and employers, as well as federal money for Planned Parenthood.   Please note that key provisions in the ACA cannot be overturned through reconciliation, such as coverage requirements, caps on annual spending, or provisions related to pre-existing conditions.   There are provisions in the ACA such as promoting preventive services (i.e. colorectal cancer screening) that also enjoy significant bipartisan support.  The ACA expands Medicaid too—including in many states held by Republicans.  Other notable provisions that Congress must consider when repealing the ACA: the ACA authorized ACOs, authorized the CMS’ Center for Medicare & Medicaid Innovation (CMMI), and authorized the FDA approval of biosimilars. (More on the ACA and impact on MACRA in this week’s “MACRA Tidbit for the Week”)

    • Please keep in mind that President–elect Trump can take executive actions as well, such as not enforcing the individual mandate, ceasing outreach during open enrollment periods, as well as stop defending ACA lawsuits’ focus on federal subsidy payments.

    Other legislation: Congress must reauthorize the Children’s Health Insurance Program as well as drug manufacturer user fees collected by the FDA.  This may trigger debates on Medicaid “per capita” payments or block grants, as well as on high drug costs.

    For your radar screen: Vice President-elect Pence may play a crucial role on Capitol Hill.  He would be the 51st vote as President of the Senate for any contentious legislation.  Pundits expect him to be the key person on relationship building between the White House and Congress.  For example, Vice President-elect Pence may be assigned the key role in crafting policy and negotiating with Congressional leaders.  He may be a key bridge between President-elect Trump and Paul Ryan (if reelected as Speaker of House) and the House Republican Freedom Caucus, as well as the conduit between the White House and the Democrats.

    Already looking to 2018?  Some things to think about:

    If you are a Republican, the 2018 election-cycle looks in your favor.  Of the 25 democratic and independent U.S. Senate seats up in 2018, many of these states voted for President-elect Trump (FL, IN, MI, MO, MT, ND, OH, PA, WI, and WV)

    If you are a Democrat, the presidential mid-term elections are usually a referendum on the President.  President-elect Trump will enter office as a very polarizing figure and lost the popular vote (at the time of this writing).  Republicans also have no one to blame in 2018, since they will be controlling the U.S. House, the U.S. Senate, and the White House.  Ironically, repealing the ACA could hurt Republicans in 2018.   It remains to be seen how Republicans can repeal the ACA, but not displace the 20 million Americans receiving private health insurance or Medicaid via the ACA.  Also, the timing and issues associated with any Supreme Court nomination may present a challenge for Republicans, who at the same time, will be trying to reconcile with and win over the younger and more diverse voter population.

    Whitfield L. Knapple, MD, FACG

    Chair, ACG National Affairs Committee

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