The next president will have continued influence over the practice of medicine. Thus, it is important to analyze each candidate’s positions statements and words as to their impact on the practice of emergency medicine.
Beginning with Hillary Clinton, she has stated “as we see more consolidation in health care, among both providers and insurers, I’m worried that the balance of power is moving too far away from consumers .” Two policy positions she has espoused – protecting patients from cost-sharing and expanding Medicaid through the Affordable Care Act – have implications for emergency physicians.
Hillary Clinton promises to “bring down out-of-pocket costs like copays and deductibles .”
Despite the fact the total amount of healthcare paid out-of-pocket has been decreasing over time, the issue of high out-of-pocket costs for patients has intensified. The number one reason is that high deductible health plans have become increasingly popular, especially among the newly insured, highlighting the issue for healthcare consumers. Most solutions described by policy makers aim to allow patients off-the-hook for the financial consequences of seeking healthcare care.
Clinton’s specific plan to reduce out-of-pocket payments – allowing three cost-free sick visits per year – may not directly impact emergency physicians but her ideas about balance billing are downright threatening.
Under Hillary Clinton’s plan, Americans will benefit from expanded disclosure requirements and new cost-sharing protections that will ensure they will be required to pay no more than in-network cost-sharing for any care received in a hospital in their plan’s networks and for any emergency services in a true emergency .
With balance billing a burgeoning issue in many states, Clinton’s plan would be a bitter pill for emergency physicians. If her solution is allowing health insurers unfettered ability to hide behind the unfunded EMTALA mandate, physicians can expect reimbursements for their services to be driven lower by private payers who have no incentive to negotiate in good faith with emergency physicians.
But on the bright side of things, Clinton promises to fight for health insurance for the lowest-income Americans in every state by incentivizing states to expand Medicaid.
Medicaid expansion is undeniably a win for emergency medicine. Medicaid expansion allows “no-pay” patients to become “some-pay” patients. One study predicted that emergency physicians would see 17% better collections for outpatients gaining Medicaid coverage. Since the ACA’s Medicaid expansion began hospital nuances have improved ; similar trends are emerging from recent analysis of emergency physician billing data .
While some detractors might complain that the cost of expanding Medicaid falls on the rich (that includes physicians), it should be noted that emergency physicians in non-expansion states are already paying the higher taxes needed to fund Medicaid expansion for colleagues in other states.
Shifting gears, Donald Trump sounds the alarm that life as a physician is getting more and more difficult. “Doctors are quitting the business. I have a friend who was a doctor and he says he has more accountants than patients .” Hyperbole aside, the impact of Trump’s policies for emergency physicians is difficult to predict.
Trump would “require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.”
The goal of price transparency is to decrease the overall price of health care services under the theory that informed consumers will choose lower cost providers. Presuming that theory works – which is a dubious proposition – price transparency might better serve patients and payers than providers. Physicians could suffer if prices fall in health care.
On another issue important to emergency physicians Trump states, “we need to reform our mental health programs and institutions in this country… There are promising reforms being developed in Congress that should receive bi-partisan support.”
Perhaps Trump is alluding to H.R. 2646 “Helping Families in Mental Health Crisis Act of 2015” which recently passed the House of Representatives. The American College of Emergency Physicians supports this bill but it still needs the support of doctors to get through the Senate.
Lastly, the two candidates differ on another issue important to emergency physicians. ACEP policy argues for legislative, regulatory, and public health efforts that “support universal background checks for firearm transactions .” Hillary Clinton supports this viewpoint; Donald Trump opposes it.
The next four years will certainly pose challenges for physicians as the health care system continues to experience disruptions from the status quo. Some of these changes will be good for emergency medicine and some will be bad. Regardless, it is paramount that each physician engages in the political process to elect whomever he or she determines will best represent the interests of that individual, his or her patients, and our nation as a whole.
- Reuters, “Clinton has ‘serious concerns’ about Aetna-Humana, Anthem-Cigna mergers,” October 21, 2015.
- Pines, J, et al. Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix. Health Affairs 35, no.8 (2016):1480-1486.
- C-SPAN, “Iowa Freedom Summit, Donald Trump,” January 24, 2015.
- American College of Emergency Physicians. ““Firearm Safety and Injury Prevention” April 2013. https://www.acep.org/clinical—practice-management/firearm-safety-and-injury-prevention/