How will patients fare under the Trump administration? Not too well, according to a new NEJM Catalyst survey.

In February 2017, 1,058 members of the NEJM Catalyst Insights Council participated in the survey. The council members — executives, clinicians and clinical leaders at healthcare organizations — were asked to predict how the Trump administration’s plans would impact American healthcare.

“Since healthcare was one of the top topics debated in the run-up to the presidential election, we knew our Council members would be deeply concerned about the impact of the new administration on patients, providers and hospitals,” Ed Prewitt, Editorial Director of NEJM Catalyst and co-author of the report, told MedCity via email.

The responses? “Overall, Council members express pessimism about the healthcare landscape in the wake of the Trump administration’s proposed plans, citing no clear winners, only losers: patients, clinicians and provider organizations,” the report’s authors wrote.

In fact, 44 percent of respondents predicted patients will be very negatively impacted by Trump’s plans, and 29 percent said patients will be slightly negatively impacted.

Prewitt attributes this prediction to respondents’ belief in Trump’s promises about healthcare. Via email, he told MedCity:

When we surveyed the NEJM Catalyst Insights Council soon after the election, it was clear that our members were taking Trump’s promises seriously. They predict that many people will lose insurance coverage, that insurance premiums will rise and that insurance benefits will decrease. All these predictions would probably have come to pass if the American Health Care Act — the administration’s first attempt to replace the ACA — had been enacted. That bill did not pass, but it indicates the administration’s intent.

The majority of respondents also said clinicians and provider organizations will see a slight or very negative impact. However, there was no clear consensus among council members on how Trump’s administration will affect pharmaceutical companies, payers and employers.

Respondents also weighed in on the overall healthcare landscape. Sixty-nine percent said they expect premium prices to either slightly or significantly increase under Trump. The majority of respondents believe insurance benefits coverage, the number of individuals covered and funding for medical research will either slightly or significantly decrease. There was not a clear consensus on how drug pricing and the shift toward value-based payment will change with Trump as president.

As far as the ACA is concerned, the majority of respondents believe it will at least be repealed within one year. Twenty-seven percent said the ACA would be repealed and replaced, and 35 percent believe it will be repealed with a replacement indefinitely delayed.

Meanwhile, 28 percent of respondents said the ACA will remain mostly intact over the next year.

Some respondents were candid on their hopes for the future of healthcare under the president’s administration. “Trump will be impeached and we can get on with the hard work of health care transformation. Otherwise, there is no hope,” one executive wrote. “I would hope that they will keep the parts of the ACA that are working and replace others and that they carefully weigh each aspect rather than repeal the entire Act due to partisan politics,” a department chief said.

NEJM Catalyst expressed a slightly more optimistic viewpoint. “While we share Council members’ deep concern about the impact of the Trump administration, we hope that the ultimate outcomes will be positive — for the healthcare delivery system and the health of patients alike,” the report reads.

We’ll have to wait and see.

Photo: Drew Angerer, Getty Images