Politics and Medicine: What Doctors Are Worried About for Healthcare Reform

Politics in the Exam Room: Doctors Speak Out on Healthcare Concerns Ahead of the New Administration

As the political landscape in the United States shifts once again, healthcare professionals are bracing for significant changes under the new administration. The nomination of Robert F. Kennedy Jr. (RFK) to head the Department of Health and Human Services (HHS) has caused concern among many physicians, as his outspoken stances on issues like vaccination and fluoride have raised alarms. However, the larger picture of healthcare reform—centered on issues such as insurance coverage, access to care, and reimbursement rates—remains a pressing concern.

In a recent roundtable discussion with healthcare professionals across the country, Medscape Medical News reached out to physicians, who expressed their thoughts on the potential impact of the incoming administration on healthcare policy. From vaccine skepticism to the fate of the Affordable Care Act (ACA), these experts offered their perspectives on the most pressing issues affecting the medical field today.

Issue #1: Vaccines and Public Health

The ongoing COVID-19 pandemic and the politicization of vaccines have brought vaccine policy to the forefront of healthcare discussions in America. RFK’s stance as a vocal vaccine skeptic has raised significant concerns among healthcare professionals, particularly pediatricians and public health experts.

Keith English, MD, a professor and chair of the Department of Pediatrics and Human Development at Michigan State University, voiced his alarm at the prospect of RFK leading HHS. “RFK has been an anti-vaccine conspiracist for decades,” he said. “He has allied himself with individuals who have actively tried to undermine vaccines.”

Vaccine hesitancy has been a persistent challenge, even as we’ve witnessed outbreaks of preventable diseases like pertussis and tetanus. Dr. Laura Carravallah, an internist in Flint, Michigan, recalled the devastating outcomes of unvaccinated individuals contracting preventable diseases. “We had two patients — one child and one adult — who had to be intubated in the ICU for weeks to survive,” she explained. “It was awful.”

For Dr. Michael Gerling, an orthopedic spine surgeon in New York and New Jersey, the importance of immunization is clear: “We need to support the public health benefits of vaccines, which are well-documented and critical in preventing the spread of infectious diseases.”

Physicians agree that instead of engaging in personal attacks, it’s important for the medical community to promote a more fact-based, respectful conversation. “We need to keep explaining why immunization is so important,” said Dr. English, “and recommend qualified nominees to lead HHS who understand the significance of vaccination.”

Issue #2: The Future of Medicare and Medicaid

Medicare and Medicaid have long been pillars of the U.S. healthcare system, providing critical coverage for millions of Americans, especially the elderly and low-income populations. However, cuts in reimbursements for healthcare providers—especially private practitioners—have made it increasingly difficult for doctors to continue treating these populations.

Noah Greenspan, PT, a board-certified clinical specialist in cardiovascular and pulmonary physical therapy in New York City, shared his frustration with Medicare reimbursement rates. “Every year, they lower the amount we get paid,” he explained. “While a 2.8% cut might seem small, it adds up over time. The cost of rent, equipment, and other overheads doesn’t decrease, yet reimbursement continues to shrink.”

Dr. Carravallah also highlighted the inefficiencies associated with Medicare Advantage Plans, which, while designed to cut waste, have not shown tangible improvements in service. “These plans are supposed to improve care, but all they do is drive up drug costs and increase the administrative burden on physicians,” she said.

The future of Medicare and Medicaid under the new administration remains uncertain, and physicians are concerned that continued cuts could have detrimental effects on the accessibility and quality of care for vulnerable populations.

Issue #3: In Vitro Fertilization (IVF) and Reproductive Health

Infertility has become a significant healthcare concern, with one in six couples struggling to conceive, according to the World Health Organization (WHO). As a result, In Vitro Fertilization (IVF) has become a critical tool for many families. However, the coverage and accessibility of IVF remain highly variable across the U.S., with only 19 states mandating insurance coverage for infertility treatments.

Dr. Thomas Molinaro, a reproductive endocrinologist and chief medical officer at IVI-RMA North America, emphasized the importance of consistent national support for IVF. “Having IVF reach the national stage as an election issue was surreal,” he said. “It highlights the need for federal protections to ensure that all couples, regardless of where they live, have access to the care they need.”

With the average cost of an IVF cycle ranging from $12,000 to $17,000, many patients are left to pay out of pocket, further exacerbating inequities in reproductive healthcare. Dr. Molinaro hopes the new administration will consider policies to make IVF more accessible and ensure that fertility preservation, especially for cancer patients, becomes a standard part of healthcare offerings.

Issue #4: Women’s Reproductive Health and Abortion Rights

Women’s reproductive health has become a hot-button issue, particularly regarding abortion access and the ability of doctors to provide necessary medical care. Kecia Gaither, MD, MPH, a maternal-fetal medicine specialist at NYC Health + Hospitals/Lincoln, voiced concerns about how current political dynamics are already affecting her ability to care for women.

“When women are experiencing miscarriages, they need timely and appropriate medical intervention,” Dr. Gaither said. “Unfortunately, there are cases where physicians are reluctant to provide this care due to fear of legal consequences.”

The ongoing debate about abortion access has also raised alarm among physicians, particularly those dealing with high-risk pregnancies. “There are situations where fetuses are diagnosed with fatal anomalies—such as missing vital organs or conditions like Trisomy 13 and 18,” Dr. Gaither explained. “In these cases, women should have the right to choose whether to continue the pregnancy or not. Forcing women to carry these pregnancies to term can lead to unnecessary suffering for both the patient and the family.”

Dr. Gaither’s concerns extend to the increasing number of obstetricians who are opting out of the field due to restrictive policies. “This leaves many underserved women without access to the care they need,” she said.

Issue #5: The Affordable Care Act (ACA) and Health Coverage

The ACA, also known as Obamacare, has provided coverage to millions of Americans, but it has also faced significant criticism for issues related to premiums, tax increases, and physician workload. As discussions about the future of the ACA heat up, many healthcare professionals are worried about the potential loss of coverage for millions of people.

Dr. Gerling, an orthopedic surgeon, pointed out that while cost-cutting and efficiency are important goals, they need to be approached with expertise and credibility. “The question is, who is going to be responsible for modifying these policies?” he said. “It’s crucial that the people involved have the experience and qualifications to understand the complexities of healthcare.”

Dr. Gaither echoed these concerns, noting the significant socioeconomic disparities that exist in terms of access to care. “While politicians may agree that everyone deserves healthcare, the reality is that the system doesn’t always provide equal access to care,” she said.

The potential for major changes to Medicare, Medicaid, and the ACA under the new administration raises questions about how healthcare will evolve and whether millions of Americans will lose their insurance coverage.

Conclusion: Healthcare in a Time of Political Uncertainty

As the new administration prepares to take office, the future of U.S. healthcare remains uncertain. From vaccine policy and reproductive health to the fate of Medicare and the Affordable Care Act, the issues that doctors and patients face are deeply intertwined with political decisions. It is clear that healthcare professionals are concerned about the potential impact of these decisions on the quality and accessibility of care.

In these uncertain times, it is more important than ever for physicians to advocate for their patients, engage in respectful conversations about healthcare policy, and push for solutions that prioritize the health and well-being of all Americans. While the political landscape may shift, the core values of providing high-quality, accessible, and equitable healthcare for all must remain at the forefront of the conversation.