EPtalk by Dr. Jayne 11/10/16

Most of the physicians I have interacted with over the last two days have commented about potential healthcare impacts from Tuesday’s election. Although the potential repeal of the Affordable Care Act was at the top of multiple conversations, there were many local and state questions with a health-related focus.

Colorado voters failed to pass Amendment 69, which would have allowed for a single-payer healthcare program to replace the state’s insurance exchanges and also private plans. Voters there approved Proposition 106, which would allow physicians to prescribe lethal drugs to terminally ill adults who are certified by at least two physicians as having less than a six-month life expectancy. Colorado voters also said no to increased tobacco taxes, with similar rejections in North Dakota and Missouri. The latter had two tobacco tax issues on the ballot, which likely caused confusion.

Regarding other smoking options, medical marijuana was legalized in Arkansas, Florida, and North Dakota, while Montana amended its existing regulations. Recreational marijuana use was approved in California, Maine, Nevada, and Massachusetts. Those eager to partake will have to wait a bit longer while states finalize the details around the actual sales and dispensary processes.

California voters approved a tax of one cent per ounce on sugar-laden drinks in Oakland, San Francisco, and Albany, while voters in Boulder, Colorado approved a two cent tax. California voters also elected to continue fee assessments on private hospitals, with the proceeds being used to fund Medicaid.

The most interesting ballot questions I saw were in Florida, with two non-binding referendums on the release of genetically modified mosquitoes to reduce disease. It’s an interesting idea as a public heath intervention and passed in Monroe County, but not in Key Haven. I’m a big fan of Jurassic Park and I can’t help but wonder if voters thought about what happened with those genetically modified dinosaurs when they made their decisions.

California was certainly a leader in the number of health-related questions, although voters failed to pass Proposition 61, which would have blocked pharmaceutical companies from charging state payers more than they charge the Department of Veterans Affairs. Not surprisingly, big pharma spent more than $100 million to oppose the measure.

Although the president-elect promised to repeal the Affordable Care Act as part of his platform, Republicans failed to earn a filibuster-proof majority in the Senate. The ACA was a long time in the making and had support from both sides of the aisle, so efforts to reverse are sure to be interesting. Filibusters are always attention-grabbing as well as a way to hear some interesting literature and potentially pick up some new recipes.

There is a chance that a budget reconciliation maneuver might be used, which only requires a simple majority, but this requires a review of the parliamentary process around budgeting to ensure that the process is compliant. This process was used earlier this year, but the bill ultimately suffered a Presidential veto.

Changing the ACA might be more difficult than people think, as more than 20 million people would stand to lose insurance coverage. Additionally, many Americans have been pleased with the portions of the law that protect patients with pre-existing conditions and extend the length of time that dependents can remain under their parents’ coverage. This enthusiasm has been tempered, however, by concerns over high coverage costs and rising premiums.

Trump has also mentioned allowing the import of prescription drugs from outside the US, as well as allowing Medicare to negotiate drug pricing directly with pharmaceutical manufacturers. Similar efforts have been blocked by the GOP in the past, so it will be interesting to see what’s different this time. It’s likely that a Republican-controlled legislature will take up the issue of funding for Planned Parenthood and perhaps other regulations related to reproductive healthcare.

The issue of filling the existing vacant Supreme Court spot was also the topic of several discussions. I’m sure the nomination process will be interesting once our new president takes office. We’re certainly in for an interesting ride over the next several months.

What chatter are you hearing about the future of healthcare after the election? Email me.

Email Dr. Jayne.