Trump's healthcare policy: The Ben Carson effect

Ben Carson, M.D., who ran against Donald Trump in the Republican primary and then endorsed him, is poised to play a significant role in Trump's healthcare agenda.

Carson is said to be in the running for secretary of the Department of Health and Human Services in a Trump administration, Politico reports. In an interview with the news outlet, Carson said “of course” he intends to help create an Affordable Care Act replacement.

“The replacement must come first” before dismantling the current healthcare reform law, Carson said.

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Ben Carson

For starters, Carson's influence could mean a greater emphasis on health savings accounts. Carson, a retired neurosurgeon, campaigned on replacing the ACA with a plan that includes what he dubs "Health Empowerment Accounts," tax-free savings accounts that people could use to cover out-of-pocket expenses and premiums for the insurance plan of their choice. 

Paul Ginsberg, Ph.D., director of the Brookings Institution health policy center, told FierceHealthPayer that HSAs fulfill ideological purposes instead of playing a role in boosting patient coverage.

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The accounts are useful for high-income individuals with high-deductible health plans, as they can serve as both transactional and investment vehicles, but are not much use to low- and middle-income individuals, Ginsberg said.

Scott Atlas, M.D., along with John Cogan, Ph.D., both senior fellows at the Hoover Institution, have argued that the ACA should be replaced with a system of high-deductible health plans (HDHPs) and HSAs, both of which they say could encourage consumers to be more selective about healthcare spending.

The pair said that health reform legislation should include raising the maximum allowable contribution for HSAs and expanding scope and penetration of services and products consumers can buy with them.

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However, the use of HDHPs in conjunction with HSAs also may mean higher out-of-pocket costs for patients with chronic conditions.

For its part, America's Health Insurance Plans has said it supports legislation that would adjust HSA rules to cover care for chronic conditions before meeting deductibles.