The future of gastroenterology is enmeshed in politics. From the partisan battles that led to the Affordable Care Act (ACA) to last week’s party-
line approval of the American Health Care Act (AHCA) by the House of Representatives, every gastroenterologist, practice and academic center is tied to politics.
“In 2008, the Democratic Party declared that every American should have affordable health care. In 2016, the Republican Party came to power with repealing the ACA as one of the top items on their platform,” said Spencer Dorn, MD, MPH, MHA, AGAF, the opening speaker at Saturday’s AGA Clinical Symposium Gastroenterology in the Age of Trump. “Defining the value proposition of health care and GI care for our patients is the only way we are going to survive.”
Regardless of political affiliation, one of the key health care policy issues is the undisputed need to reign in costs, explained Dr. Dorn, associate professor of gastroenterology and hepatology at the University of North Carolina at Chapel Hill. While the ACA slowed the rate of growth in health care expenditures, health care still accounts for about 18 percent of gross domestic product and continues to rise, he said.
Dr. Dorn identified the three primary goals of the ACA: extend insurance coverage, regulate the health insurance industry and create new, more effective systems to deliver health care. The ACA largely met these goals, he said. Health coverage became more affordable and the rate of increase on health care spending slowed.
“When Republicans took control of Congress in 2016, they systematically blocked technical corrections to the ACA like colonoscopy adjustments. Then they gave us the AHCA,” said Dr. Dorn.
The Congressional Budget Office has not yet scored or evaluated the version of the AHCA passed by the House. Agency projections for an earlier version of the bill showed a $337 billion decrease in the federal deficit by 2026. The agency also estimated that 24 million more Americans would be uninsured by 2026 under the earlier version of the legislation compared to the current insured rate under the ACA.
Meanwhile, initial budget proposals for fiscal year 2018, which begins in September, do not bode well for gastroenterology, Dr. Dorn said. The so-called “skinny budget” proposed by President Trump in March calls for increased spending for the Veterans Administration, homeland security and defense. All other federal spending is to be cut.
Proposed cuts range from 31 percent to the Environmental Protection Agency to 1 percent for NASA. Health and Human Services would see an 18 percent reduction in funding, a loss of about $15 billion. HHS cuts include a $403 million reduction in medical training and a $5.8 billion cut to the National Institutes of Health.
“The biggest concern is the impact on research,” said Folasade May, MD, PhD, MPhil, assistant professor of medicine at the David Geffen School
of Medicine, University of California, Los Angeles. “Senior investigators may have to lay off staff and junior scientists may not be able to pursue academic careers.”
The positive news is that the Trump budget is only a proposal and Congress seems inclined to support scientific research, she said.
After several years of flat funding, NIH will receive an additional $2 billion through the continuing resolution signed by President Trump on Friday. The White House is expected to release its complete FY2018 budget proposal later this month.
“We all need to get informed and we all need to get engaged in advocacy on funding,” Dr. May said. “Under the proposed cuts, university and academic medical institutes would face great challenges in continuing to support medical research.”