As we move into an era of a Republican trifecta in the federal government, it is important for all CANS members to understand how this might affect healthcare in California. Obviously, some of the expected changes may not seem that pertinent to the practice of neurosurgery but public health policy, as one example, could have ramifications for all of us.

The first thing to remember is that the top priority for President Trump and a Republican Congress with be to extend the Trump era tax cuts. Tax bills require 60 votes in the Senate, but the budget reconciliation process only requires 51 votes. What this will mean for healthcare is unclear, but health programs will undoubtedly be cut and with 1/3 of Californians on Medi-Cal, we stand to feel squeeze.

The Affordable Care Act (ACA) has 45 million Americans enrolled in it with 8 million Californians in Covered CA and 3.7 million in Medicaid expansion. If the ACA is repealed, replaced or otherwise changed this could result in a reduction of essential health benefits via more restrictive plans, creating state-based high-risk pools for those with pre-existing conditions and higher patient cost-sharing with insurance industry deregulation.

Then there are the issues with having more government regulation into the decisions we make with our patients. OBGYNs may not be able to prescribe mifepristone to a teenager who was sexually assaulted, endocrinologists may risk criminal charges when they counsel the family of a child with congenital adrenal hyperplasia.  This may affect our workforce as MDs move to states where they can practice without the fear of prosecution.

There may also be cuts in federal funding to schools, like those in California, that have vaccine mandates and differences in FEMA aid to states based on political affiliations. While this is mostly conjecture at this point, it is worrying all the same.

The AMA and CMA have both released statements about their commitment to working with the incoming administration to protect the health of Americans. Fortunately, there is bi-partisan work underway to reform Medicare payment, provide relief from the burden of prior authorization and expand telehealth.  In closing, I will quote part of the AMA statement: “Politics or ideology, from either side of the political divide, cannot lead the way when they diverge from where science and evidence lead us”.  We shall see.