Health Care Executives Predict No Winners Under Trump Administration

Survey finds doom and gloom

In February 2017, members of the NEJM Catalyst Insights Council––a group of executives, clinical leaders, and clinicians at organizations directly involved in health care delivery––were asked to predict the Trump administration’s impact on health care in America. Overall, council members were pessimistic about the health care landscape in the wake of Trump’s proposed plans, citing no clear winners, only losers: patients, clinicians, and provider organizations alike.

For example, 73% of survey respondents predicted that the number of U.S. citizens covered by health insurance would decrease. Subsequently, in its analysis of the GOP’s plan to pass the American Health Care Act (AHCA), the Congressional Budget Office (CBO) calculated that 14 million people would become uninsured by 2018, rising to 24 million by 2026.

In another example of the council’s foresight, nearly 70% of survey respondents anticipated that insurance premiums would increase. The CBO assessment of the AHCA estimated that premiums would rise 15% to 20% for single policyholders in 2018 and 2019 (before beginning to decline in 2020).

Survey respondents also forecast cuts in medical-research funding, with 67% saying funding would either decline significantly or slightly. Soon after the survey was conducted, the Trump administration unveiled its proposed budget, which included deep cuts to medical research.

The respondents were divided on the time frame for new health regulations from the Trump administration. Sixteen percent thought it would happen within six months. Just over half (51%) thought the window would fall between seven and 24 months. Nearly a fifth (18%) of the respondents predicted that a comprehensive health care plan will never arrive.

Council members were pessimistic about anticipated changes to the health care landscape on several significant issues––particularly health insurance. More than two-thirds of the respondents (69%) expected insurance premiums to rise. At the same time, 70% predicted that coverage benefits would decline, and 74% predicted that fewer U.S. citizens would be covered by insurance.

With regard to drug pricing, 36% of survey respondents believed prices would increase, and 28% believed that prices would stay the same. Higher percentages of executives (31%) and clinical leaders (34%) thought drug prices would stay the same than did clinicians (24%).

The survey respondents––all of whom were directly involved in health care delivery––were particularly gloomy about the impact of health care changes on themselves and their organizations; 63% said clinicians would be negatively affected, and 62% said provider organizations, such as hospitals, would be negatively affected. Respondents thought payers were likely to come out ahead (46% positive versus 36% negative) under the Trump administration, but were mixed in their views on the prospects for employers and pharmaceutical companies.

Council members also expected significant budget cuts to government health care and regulatory organizations. The Centers for Medicare and Medicaid Innovation was given the highest likelihood of being targeted (chosen by 69% of respondents).

A total of 1,058 completed surveys were included in the analysis.

Source: NEJM Catalyst Report; April 2017.