• Status quo is maintained with low risk for change-- very good for health sector • Likely to have a Democratic Senate • 4 – 8 years of stability, few provider cuts, slow move toward capitation/bundles, etc. But with a friendlier relationship with Congress than Obama • IMPACT ON HEALTHCARE INDUSTRY: • Positive for healthcare with dollars going into the system • RISK: Major bipartisan budget deal in 2017 Scenario A: President Clinton
Scenario B: President Trump • High risk for chaos come January 2017. Market chaos the day after the election • Obligated to repeal and replace w/ GOP Congress • 2 year transition period is likely to avoid implosion • IMPACT ON HEALTHCARE INDUSTRY: • Likely to cause a big stir and decrease healthcare spending. Conservative Congress will do a tax and health budget deal. It will be tough on Medicare $ and Medicaid reform Will cause huge uncertainty and volatility in valuations. Very tough on public stocks. • Buying opportunity at the right time? • RISK -- Everything! (Could have been Cruz! )
today nationally (Clinton 54-41); (note: Clinton Kasich; 44-51!!) • There is sure to be a big shift in the Senate -- almost certainly a Dem majority. , Dems need +4 , with Clinton win they probably win 7-8. Many moderate GOP could lose? (Toomey, PA; Portman, OH; Burr, NC; Ayotte, NH; Johnson, WI). All in serious danger if Trump is trounced. • Clinton will likely focus on health care as little as possible. Has not been kind to her. She will protect the ACA and push for more Medicaid expansions. • With Sen. Schumer running the Senate and Speaker Ryan there is a GOOD chance for a big budget deal. Schumer and Ryan like deals– and there will be pressure for some action. • Schumer and Clinton will try to protect Medicare, Ryan will try to avoid big tax changes. But any deal would have to be a net negative on Medicare.
coverage available through exchanges regardless of immigration status (no subsidy without documentation) • Public option available as state option • Tax credit up to $5,000 to offset out-of-pocket and premium costs over 5% of income • Ceiling exposure of 8.5% income for exchange participants • Government action to reduce Rx drug costs • State option for public option
+24 over Kasich. Hard to see how Trump is not the nominee (despite WI). If he somehow behaves better and moves to the middle, could he catch Clinton and win OH, PA, MI and some NE states too beat her? • If so, there will be a stable and possibly larger Senate GOP majority. The House will have massive majority for Rs. • Very strong pressure to REPEAL AND REPLACE NOW. They will have to vote in January 2017. If it does not pass the Senate they will use reconciliation (50 votes) and pass it by February. • Medicaid expansions in the South? Dead. • This will send a confused chill through heath care stocks and investments. In the long run little will change– except slower spending growth. But chaos in Congress will reign on health.
(mostly a joke) • Repeal ACA • Affordability – Tax credits to help individuals purchase coverage on identical basis for employer- provided coverage and individually purchased – New limits on employee exclusion – Enhanced competition by sales across state lines • Repeal coverage requirements – Minimum essential coverage – Prohibition of medical underwriting – Addition of subsidized high-risk pools – Mandated coverage • Entitlement reform – Medicaid converted to block grants (not Trump); Per capita allocation (Kasich) – Medicare evolves to defined contribution
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