How will health care change under a Trump presidency?

"I don’t know what to expect from any aspect of the President Trump camp. There is so much vagueness in what he says," one urologist said.

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: How will health care change under a Trump presidency?

Dr. Guleria"I don’t know what to expect from any aspect of the President Trump camp. There is so much vagueness in what he says. He wants to repeal the ACA-what happens after that I don’t know. When does the repeal happen? How long does the process take? What is it replaced with, if you repeal it?

I don’t think repealing the ACA will affect my practice too much either way. We don’t have a lot of ACA patients that I know of anyway because plans are not labeled specifically ACA. I have an ACA plan for myself and my kid because it was better, cheaper than other group plans we had available.

This coming year, our practice has been looking into group plans again, so we may end up changing out of the ACA anyway. We don’t have a ton of uninsured; I still have some despite the ACA, so I don’t think ending the ACA will affect my practice too much.

We tend to have a pretty high population of insured patients and a lot of the ones who are typically uninsured don’t qualify for the ACA because they’re not legal immigrants or whatever, so they just pay cash.”

Anshu Guleria, MD

Manassas, VA

Next: "I don’t think anybody expects to hold [Trump] to exactly what he says, but it will definitely change.”

Dr. Gervasi"Trump campaigned saying he would repeal Obamacare. With Republicans [having] the majority in the Senate and the House, that might happen.

Read: MACRA leaves urologists confused, skeptical

If the whole thing is repealed and we have to start over, it’s going to be a much bigger thing. Go back to the old system? How do we do that?

We just had a presentation on this by Newt Gingrich at the LUGPA meeting. The ACA has worked for people who are uninsured-the lowest income people. About 75% of those people enrolled. That makes sense. But in higher income brackets, fewer people enrolled. Part of the reason is payments are just too high. The question is how do we fix that? Do we keep some of it in place, or just throw everything out? The [Trump] administration would more likely include the private sector, which goes along with his campaign platform.

We basically did OK with the old system. With the ACA, we’re seeing more people who have the equivalent of Medicaid, basically Medicaid expansion patients. Those are some of the lowest paying people coming into our practice. It wasn’t a big income boon for our practice.

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I don’t think anybody expects to hold [Trump] to exactly what he says, but it will definitely change.”

Lawrence Gervasi, MD

Cleveland

Next: "To be quite honest, the ACA really hasn’t affected me."

Dr. Fischman"To be quite honest, the ACA really hasn’t affected me. My patients are largely elderly and have Medicare or Medicare HMOs. So I really don’t see Obamacare patients.

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I don’t know what he’s actually going to do with health care, but I would hope any new plans do away with pre-authorization requirements. I have two employees who can easily spend a half-hour on the phone if I need pre-authorization.

A few things in the ACA are good, like coverage for pre-existing conditions. But the ACA does affect people I know. A friend realized she was going to make more than she had expected this year, more than she had told them, and that meant she would lose her subsidy. So even though she wanted to work more overtime, she was afraid she would get hit with a penalty. That actually discouraged people from working more.”

Nathan Fischman, MD

New Orleans