Trump v. the ACA: inevitability takes a beating

By B.J. Richards

One of the perks of being a Source analyst is that we get to pick the brains of some of the world’s top consulting talent as a routine part of the job. And sometimes, if we’re really lucky, we get to question them on a topic that’s not only important to Source’s research but of great personal interest as well. And so it was with great anticipation that I approached my first post-election meeting with a US consulting leader in late November last year. Like many of my fellow Americans, the elevation of one Donald J. Trump to the highest office in the land had me in a state of shock: The inevitable had been thwarted, and the impossible had come to pass. It was disorienting, and I was eager to talk to someone who I believed could tell me ~*what it all meant*~

“Well, first of all, you have to understand that the ACA is done,” he said before launching into a well-trodden explanation of the impact this could be expected to have on the healthcare market. The answer was not merely disappointing; it was downright insulting. Didn’t he understand that I, too, am a highly-educated professional with paid-up subscriptions to all the very best newspapers? I mean, obviously the ACA was dead. Obviously, that would be the first thing to happen. Obviously, that’s not what I was asking. His next spiel about the inevitability of a tax overhaul was equally galling.

In retrospect, it seems very unfair to have expected him to have any better grasp on the suddenly hazy future than I, or anyone else, did. And indeed, he did not: A year out from the election, we find that Donald Trump has made fools of us well-read folks again and again. The few things that seemed like sure bets in the post-election world have not come to pass: The ACA lives, despite having a few chunks knocked out of it via executive order; a tax proposal is on the table, but it’s far from a done deal; infrastructure has seen talk but little action. As with the election itself, the inevitable has seemingly been thwarted. In both victory and defeat, Trump has proven an uncanny ability to blow up expectations and keep that feeling of disorientation going strong.

And so what does all that expectation thwarting mean for consulting—specifically those US consultants serving the healthcare market, whose path seemed so clear last November 9th? So far, it’s mostly meant that their clients’ pre-election uncertainty never really went away. Many fully expected the slowdown they witnessed in advance of Election Day, but few thought it would spill over into 2017. Indeed it did, and many reported an unexpectedly slow first quarter this year.

But what happened next has been a further surprise. The consultants we’ve spoken with have told us that the new administration’s inability to get things done has actually injected a new confidence into the market. Many clients are forging ahead on the assumption that the ACA will remain in place for the foreseeable future—or else be replaced by something that’s functionally indistinguishable. Others have found a way to stay clear of murkier objectives while charging ahead on those that seem destined to stick: For example, the administration says that the transition to value-based reimbursements will continue, and so clients feel free to run with it. One wonders if financial services, construction, resources, and other industries left dangling will ultimately do the same—assume the status quo is unlikely to change quickly, feel confident that some things will stay the same regardless, and thus forge ahead accordingly.

Indeed, perhaps this slow-grinding, wait-and-see pace is what we should have expected from the new administration all along. Politicians promise sweeping change, and people often vote for it. But for better or worse, in modern, mature democracies, it rarely ever happens. Maybe that’s an inevitability we can actually count on.