Health Care Has Been Changing Fast. Here's Where It's Likely To Go Under Trump

Nov 9, 2016

Health care in the United States has gone through major changes during the Obama administration. President-elect Donald Trump and Republicans in Congress will soon have the power to flip all that. WFAE's Michael Tomsic reports on what that may mean in North Carolina.  

Republicans who'll control the presidency, U.S. House and Senate have been consistent: They'll repeal Obamacare. They say it's too expensive and hurts businesses.

The Obamacare basics are "a guarantee of access to insurance coverage even for people who may have health problems, subsides to make the private insurance coverage affordable for people who need to go buy an individual policy, and the Medicaid expansion for the poorest people," says Sara Rosenbaum, professor of health law and policy at George Washington University.  

The nonpartisan Congressional Budget Office has estimated that getting rid of all that would mean about 22 million Americans lose health insurance.

North Carolina did not expand Medicaid, so the lost coverage here would be concentrated on the Obamacare exchange. It covers about 550,000 North Carolinians, according to federal data.

Insurance companies, patients and President Obama himself have acknowledged there are problems with the exchanges, including soaring premiums. But the exchanges have made a massive difference in helping Americans get insured.

Rosenbaum says think back to the health care debate before Obama took office.

"No other wealthy democracy has an uninsured problem anything like ours; I mean that was one of the driving issues, that we were quite singular in the extent to which we left people without any reliable access to affordable health care," she says.

President-elect Trump and other Republicans have called to both repeal and replace. It's unclear at this point how much of the coverage losses a potential replacement would make up.

There's another major health care change that accelerated under Obama, in part through the Affordable Care Act: a shift in how doctors get paid.  

"Instead of volume and the amount of procedures you do, you're paid for the value of your outcomes for the patient," says Blair Childs, senior vice president of Premier. It's a Charlotte-based health care company that works with thousands of hospitals and providers.

The Obama administration has driven the change through Medicare, government insurance for people 65 and over. An example is giving hospitals bonuses or penalties based on quality metrics.

Childs says Congressional Republicans support the new incentives. 

"Those are ones I don't see changing," he says. "They actually get built onto by the MACRA legislation, which was passed by the Republican Congress. That takes what was in the (Affordable Care Act) and builds on it."

MACRA is the new law shifting Medicare payment even more towards quality over quantity. Childs expects that trend to continue, with Congress now handling the details.