The Trump administration has issued a 119-page report Reforming America’s Healthcare System Through Choice and Competition that reaffirms the administration’s effort to deregulate the healthcare industry in an attempt to encourage competition and lower costs. This healthcare manifesto is a blueprint to reform the delivery of care and consumer choice by relaxing state and federal laws.
The report issued on December 3, 2018, aligns with the position on healthcare reform the Trump administration has taken and announced since Trump’s election. Created as a response to the President’s October 12th executive order on health care, the report criticizes laws and regulations that govern the health care industry and describes how they stifle competition, and as a result, lead to ever-growing health care spending.
According to the report co-authors Alexander Acosta, Labor Secretary, Steven Mnuchin, Treasury Secretary, and Alex Azar, HHS Secretary, “This report identifies barriers on the federal and state levels to market competition that stifle innovation, lead the higher prices, and not incentivize improvements in quality.” The administration believes, and the report concludes, that the course can be reversed if addressed at four general areas: the health care workforce, the provider market, the insurance markets and consumer-focused aspect of health care.
Several recommendations to promote competition in the workforce include broadening the scope of practice for physician assistants and dental hygienists; enabling policies that broaden workforce mobility through multi-state licensing and telehealth; and reallocating federal funding for graduate medical education to address shortage of physicians. The report makes recommendations to improve competition in the provider and insurance markets by reducing the restrictions on physician-owned hospitals, repealing the certificate-of-need statutes that limit the emergence of new hospitals, repealing Obamacare’s employer insurance mandates, promoting and expanding health savings accounts, encouraging the development of flexible value-based care models, and promoting Medicare Advantage plans that “encourage value, competition and choice.” According to the report, health care may become more consumer-focused by increased price transparency and easier access to medical records.
In the light of the results in the midterm elections and Republican’s lost control of the U.S. House of Representatives, some of these proposals may face a strong push back, while some recommendations may find bipartisan support. The report drew immediate responses from different health care groups, and some reacted with criticism. The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) immediately announced that they would oppose the lifting of Obamacare’s ban on physician-owned hospitals, and as Chip Kahn, FAH’s president and CEO said: “Too many elements of the Administration’s report resort to the same old bromides that got us here in the first place, and would reverse the progress the hospitals and others are at work on.”
To the contrary, the report’s urge to ease scope-of-practice state laws that limit services delivered by various types of health care professionals received a positive response by the American Nurses Association. The ANA is convinced that if implemented, the propositions in the report will allow nurses to practice to the top of their license and full skill set, will improve consumers’ access to quality care by nurses, and will remove barriers to delivery of care for underserved populations in rural areas.
Likewise, the Small Business and Entrepreneurship Council president and CEO, Karen Kerrigan believes that the report offers productive ideas that will help small businesses with high health coverage costs. “Regulatory actions to date have been very positive, including the establishment of small business health plans and changes to transition health insurance that will give entrepreneurs, small business and their workers more affordable options,” Kerrigan said.
The report was prepared by HHS in collaboration with the Department of Treasury and Labor, the FTC, the White House and other federal agencies, and is available here.
