President-elect Donald Trump watches the election returns with his running mate and family. (Twitter via Trump)
Trump has said he would dismantle the healthcare law that has allowed uninsured millions to gain access to healthcare and has accelerated the shift to value-based care and reimbursement.
The ACA is popular among constituents nationwide, which means that even though Republicans have tried numerous times to repeal the law and they now control the executive office, House and Senate, a full repeal of Obamacare remains in question.
In a report released Wednesday morning, PricewaterhouseCoopers looked at how a Trump presidency would affect the ACA short of a full repeal.
"For Trump, the challenge will likely be making healthcare more affordable for consumers while offering plenty of choices," the PwC report said.
Health industry experts told PwC's Health Research Institute that they viewed Trump as a corporate chief executive. PwC said this means a Trump administration is more likely to rely on free market levers, such as price transparency for providers and open negotiations with pharmaceutical companies than the traditional regulatory process.
"The refreshing part of it he is bringing in completely new people and, presumable, they will re-evaluate everything that's been done in terms of policies and building for the future," Chip Kahn, president and chief executive of the Federation of American Hospitals told PwC.
But industry executives also told the PwC they were concerned about the repeal because it would mean an end to revenue and tax provisions, including tax credits to offset premium costs.
Trump's proposals include the expanded use of health savings accounts, cross-state insurance sales, increased transparency of provider prices, re-importation of medications as well as allowing Medicare to negotiate with drug makers, giving tax credits to individuals who pay out-of-pocket for their care. He has also talked of block-granting Medicaid, according to PwC.
PwC looked at eight Trump proposals regarding healthcare, giving expanded use of health savings account a high probability; and moderate rankings to repealing and replacing the ACA, allowing sales of insurance plans across state lines, re-importation of prescription drugs, allowing Medicare to negotiate drug prices and converting federal Medicaid funding to block grants.
Allowing all individuals to deduct health insurance premiums was given a low likelihood of gaining traction.
The PwC report said for payers and providers, the repeal of the aCA would have a negative impact. For providers, the requirement for more transparency and expanded use of health savings account and converting federal Medicaid funding to block grants was also given a negative rating.
Positives for payers were the provider transparency requirement and expanded use of health savings accounts.
But Trump's presidency also puts Medicaid expansion at risk. The ACA gave states the ability to grant access to Medicaid to Americans at or below 133 percent of the federal poverty level. However, many Republican-led states chose not to expand the program.
"'Repeal and replace' could ve very tough on hospitals that worked in the last process in 2009 and 2010 to accept tremendous Medicare and Medicaid reductions to help health reform happen," Kahn said. "It would be important for us to see if those two things go together. If you want to repeal, fine, but you have to repeal the whole thing. And that's going to be hard."
Congress could also use reconciliation and appropriations to cut spending to ACA programs. Some of the taxes for those programs have been unpopular with the healthcare industry.
Trump could push Republican senators to defund the consumer exchange subsidies in a budget reconciliation. He could shift control of the $3 trillion healthcare industry away from the federal government and toward private enterprises, state governments and consumers, the PwC said.