Trump’s Unexpected Win Met With Everything From Shock to Optimism Among US Cardiologists

La Inesperada Victoria de Trump Desata el Estupor y el Optimismo a Partes Iguales entre los Cardiólogos Norteamericanos

Polls and pundits predicted something different for Election Day, but Americans woke up Wednesday morning to learn that Republican Donald Trump will be the next President of the United States.

To get a sense of the reaction in the cardiology community, TCTMD reached out to physicians around the country to find out what they view as the potential impact of Trump’s win on cardiovascular care, research, and innovation.

Several expressed concerns about the effects of repealing the Affordable Care Act (ACA), which Trump has promised to do, and what that will mean for the previously uninsured individuals who found coverage through the law. Many others declined to go on the record or said their hospitals had told them not to comment. One interventionalist said he was “too depressed to respond.” Another used the terms “devastated” and “in no position to think clearly about this.” A third said his “thoughts are not currently quotable in public.” Others expressed their version of the divide the country now faces: “My daughter and I are on opposite sides so, for her sake, I do not want to comment on the elections.”

Some were more positive.

Howard Weintraub, MD (NYU Langone Medical Center, New York, NY), said, “I do not believe that there will be any immediate impact of the election on cardiovascular care, research, and innovation. However, there may actually be a better chance for these areas to thrive with Mr. Trump as president. My guess is that pharmaceutical companies will be in a better position.”

Also with an optimistic view, Gregg Stone, MD (NewYork-Presbyterian/Columbia University Medical Center, New York, NY), co-director of medical research and education for the Cardiovascular Research Foundation, the publisher of TCTMD, said: “I expect the outcomes of the election to have a positive impact on medicine and patient healthcare, as it will result in repeal of the medical device tax, incentives for innovation and business (on US soil), and ultimately more affordable healthcare coverage for all US citizens.”

The idea that the 2.3% medical device tax—enacted as part of the ACA—will be axed during a Trump presidency is also seen as a strong possibility by AdvaMed, a trade association for the medical device industry. In a statement sent to TCTMD, CEO Scott Whitaker said that in the next year, “policymakers will be dealing with a number of important policy issues, including authorization of the latest Medical Device User Fee agreement to continue improving the FDA regulatory process, repeal of the medical device tax, and ensuring that the coverage process allows patient access to the latest innovations. These have been and will always be bipartisan issues.”

Larry Biegelsen, an analyst at Wells Fargo Securities, agreed in an equity research note that it is likely the tax will be repealed, which would be positive for the medical device sector. He noted, too, that Republicans—who will control both chambers of Congress in addition to the White House—“have traditionally been more industry friendly” when it comes to agencies like the US Food and Drug Administration (FDA) and the Centers for Medicare & Medicaid Services (CMS).

Other potential positives for the medical device industry that could come from the transition in power, according to Biegelsen, are corporate tax reforms and “repatriation of overseas cash.”

But Biegelsen also sees potential risk to the medical device industry if the ACA is repealed, stemming from fewer numbers of insured people and lower procedure volumes.

Net-net, a Trump presidency creates a good deal of uncertainty, but we see the election results as a slight positive for the industry at this point,” he said.

Repealing the ACA

Moving people from the insured to the uninsured column by rolling back the ACA was on the minds of many cardiologists contacted by TCTMD, as well, although not because of the impact on the medical device industry.

“While some aspects of the bill cannot be revoked without a super majority in Congress, there are some provisions of the bill which can be rolled back and millions of people who receive subsidized insurance are at risk of losing it,” Jonathan Reiner, MD (George Washington University, Washington, DC), told TCTMD. “Some estimates put 20 million people at risk of losing their insurance.”

Khurram Nasir, MD (Baptist Health South Florida, Miami), said the results “place the entire momentum of realizing coverage among the uninsured and, as a result, access to healthcare . . . in jeopardy.”

And Robert Yeh, MD (Beth Israel Deaconess Medical Center, Boston, MA), expressed concerns “about cardiovascular care for the ‘re-uninsured’ patient population that might emerge from a potential repeal of the Affordable Care Act.”

If repeal of the law comes to pass, Michael Miller, MD (University of Maryland Medical Center, Baltimore), said he “would hope that certain provisions, such as guaranteed health coverage for preexisting diseases, not be dismantled.”

Bonnie Weiner, MD (Worcester Medical Center, MA), questioned whether people who have opted to pay the ACA penalty for not obtaining health insurance will opt in to whatever replaces the law or whether they would remain uninsured. It also remains unclear, she said, what effect overturning the ACA and replacing it with something else would have on drug prices and premiums.

Research and Innovation

Several cardiologists contacted by TCTMD also articulated concerns regarding the uncertain impact of Trump’s victory on medical research and innovation.

“As best I can tell, [Trump] has been totally silent about medical research,” Weiner said. “That is not necessarily a good thing. It certainly suggests to me that there will not be additional federal funding, but it may be that he is just ‘uninformed’ about the issue. The same is true about the impact on FDA, which would in turn affect innovation.”

If taxes are decreased under Trump, on the other hand, that might lead companies to invest more money in research and development (R&D) and in the United States rather than overseas, Weiner said. “Bottom line, I think we are going to have to wait and see,” she said.

Juan Granada, MD (Cardiovascular Research Foundation, New York, NY), echoed the idea that lowering the tax burden could release more money for R&D but was skeptical about bringing overseas R&D money back to the United States.

“Quite honestly, it is naive to believe that anybody will force technology companies to come back to the US; the incentives to go [outside the United States] go beyond financial incentives and include regional interest, strategic geographical location, and availability of qualified professionals,” Granada said.

As for innovation, Granada said, “I do not anticipate any big changes in the innovation environment; in fact, that topic was not even discussed during the presidential elections. I am sure, in the US, creative people will continue developing ideas and products in the healthcare system. I am more concerned about the credibility and stability of the political system, since funding sources favor and thrive in more predictable environments, which is currently lacking.”

Martha Gulati, MD (University of Arizona College of Medicine, Phoenix), was also apprehensive about Trump’s effect on research. “He has not given any direct policy information about what he will fund or not fund, but he is perhaps the first antiscience president,” Gulati said. “He has spoken very negatively about the NIH. . . . I think we need more information, but I do think physicians and scientists have reason to be concerned and watchful and to engage so we can be part of the conversation.”

Moreover, any anti-immigration policies might make it more difficult for scientists from other countries to come to the United States, Gulati pointed out. “We need more research, we need more funding, we need excellent researchers, and this means from this country and from around the world.”

Granada said something similar. “I am a first-generation immigrant that has worked very hard to get what I have; I have shared my entire career with amazing immigrants, women, and minorities that have contributed to the scientific development of this country. A great majority of brilliant minds come from overseas, people usually challenged by adverse social and political environments that have been seduced by the promise of joining a system based on freedom and social justice. That is why Mr. Trump’s words resonate really hard on my mind and are so difficult for me to understand. I have always admired and defended the American values and their love for the constitution. Today, I feel that we woke up in a different country, in which personal gains appear to take priority over those values that made America really a really unique place in the past.”

Yeh summed up his concerns about the potential negative impact of the election on cardiovascular research and innovation. “We are talking about a leader that has demonstrated a tenuous relationship with facts, scientific or otherwise,” he said. “I have grave concerns about what this election means for public funding for research and its impact on future innovation and care. . . . I hope the new President Trump proves many of us wrong.”

TCTMD reporters Caitlin E. Cox, Yael L. Maxwell, L.A. McKeown, Michael O’Riordan, and Shelley Wood contributed to this story.

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