POCP Blog

In a post on November 14, we laid out our view of the implications of an unexpected Trump victory on healthcare, in general, and health information technology (health IT), specifically (click here). The Office of the National Coordinator for Health IT (ONC) has a profound impact on health IT. Here are five ways the Trump presidency may impact ONC:

1. President-elect Trump has more than 4,000 political appointee positions to fill, and has started doing so. The National Coordinator for Health IT (ONC) and his/her chief of staff are among that tranche. We don’t expect that Mr. Trump or the transition team will see these roles as a particularly high priority and, if we were advising him, we’d agree. First, he’ll have to name the Secretary of Health and Human Services (HHS) who will, in turn, probably fill the National Coordinator role with someone who sees the role of ONC the same way as the president and secretary. The interim director will be the current deputy, Jon White, MD. A federal employee, Dr. White is among the classiest and smartest leaders in HHS. Furthermore, he gets our world.  He has been at ONC for 2 years and was previously the health IT portfolio lead at the Agency for Healthcare Research and Quality (AHRQ) since 2004. At AHRQ, he was the project officer for the 2006 electronic prescribing (ePrescribing) pilots and 2009 ePrior Authorization expert panel, which is how we got to know him. In our view, ONC is in very good interim hands.
2. The Office of the National Coordinator for Health IT (ONC) was created in 2004 under a Republican administration (George W. Bush), and expanded during the tenure of a Democratic president (Barack Obama). This is just one piece of evidence that both parties view health IT as being part of the solution – not the problem – given our unsustainable healthcare cost increases and the fact that we rank 11^th worldwide in the relative overall quality of our health care. Now, we understand that the word “establishment” was prominent in the election, something Presidents Bush and Obama would be the poster children for and President-elect Trump ran against. But health IT may be too far in the weeds for Mr. Trump to have formed an opinion; almost anyone from health IT who would be worthy of the post of National Coordinator would see health IT and electronic health records (EHRs) as part of the solution.
3. That said, there are different ways that ONC could operate under a Trump administration. The   Bush era budgets were very lean. The original request in 2004 was for roughly $50 million and a couple dozen staff. Six months later, the budget got zeroed out due to congressional spending cuts; HHS Secretary Thompson had to shuffle administrative money to keep the lights on. The budget was eventually restored to $61 million and 23 FTEs in FY 2007. Under President Obama and the 2009 American Recovery and Reinvestment Act, the budget grew to roughly $60 million in 2013 and 171 FTEs to $92 million in 2016 and 200 FTEs. While that’s an insignificant amount to the Federal government, President Trump may not see the need for that big of a budget or that many people. Now, we understand that under Affordable Care Act, the department was “codified,” meaning they won’t have to justify the budget every year. That said, Congress controls the purse-strings, and they could provide a much lower funding.
4. A wise man once said that people who look at the same facts with a different set of core beliefs will come to vastly different set of conclusions. There is consensus that we can’t sustain the growth in healthcare spending and the fact is that we do not rank in the top 10 on the world stage as far as the overall quality of our health care system. There are some questions about President-elect Trump’s core beliefs, but he said in debates that he’s interested in the federal government getting out of the way for private industry and Republicans have generally and recently preferred regulations be handled on a state level. To be sure, health IT is complicated with many-to-many transactions galore and some stakeholders being ready before others. The federal government can ensure that stakeholders are ready simultaneously, thereby reducing inertia or abandonment and spurring progress. We would think that ONC will be viewed as playing an important role; it just may not be as big as what it’s been.
5. ONC can be a convener, certifier, thought leader and influencer of federal and state regulations. The size of staff and budget needed for such roles can be debated; however, ONC’s influence on health IT is profound–especially in relation to what we have already pointed out is a drop in the bucket in terms of federal spending. ONC has some staff from industry, but many more that don’t have such experience. We hope they can attract more of the former, and encourage them to continue to partner with outside organizations and subject matter experts to ensure that they have the expertise to put their goals and objectives into a proper context.

To be sure, we have yet to be invited to Trump Towers, so these are just some thoughts based on experience, not insights into a process. But we will keep our ears to the ground, letting our readers know when changes have been made at ONC. And, in subsequent blog posts, we will explore other possible areas of change in health IT impacting our clients.

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