Optimism, Excitement, and Protest: An Inauguration Day Snapshot

WASHINGTON — Before and during Friday’s inauguration of Donald J. Trump as the 45th president, MedPage Today reporters were on the phone and on the scene to talk to healthcare providers — those taking care of the inauguration crowd as well as physician members of the audience — and members of Congress who are health professionals and had their own take on the day. We also were present for one of the more offbeat protest actions at the inauguration.

Rep. Eddie Bernice Johnson (D-Texas), a former psychiatric nurse, was at the inauguration. “I really don’t know Trump, but I’m going to do my best to make the best use of my working with him for the betterment of my constituents,” she said in an interview Thursday. “I just can’t sit back and say, ‘Mine didn’t win and there’s nothing I can do.’ … I just believe that if I work hard there’ll be something I can do that will represent the people of [my] district.”

At the inauguration, Lou Provost, a member of a two-person roving medical team from the U.S. Public Health Service that was on the lookout for inauguration-goers who experienced health problems, said that things had been slow so far, “which is just the way we like it.” Any minor injuries the two had seen came from people who had tripped or fallen on the soft ground near the Capitol.

Bijender Kumar, MD, medical director of Hancock Regional Hospital in Indianapolis, Ind., said in a phone interview from the inauguration that he was excited about Trump’s presidency because “we definitely need some changes in the Affordable Care Act (ACA).” Kumar said he was “proud” of Rep. Tom Price, MD (R-Ga.), President Trump’s nominee for Secretary of Health and Human Services, and that Price and Seema Verma, Trump’s pick to run the Medicare and Medicaid programs, “might make great changes” by working together.

However, Kumar said he was not in favor of completely repealing the ACA. “Twenty million people are already on it, so completely repealing it is not a good idea,” he said.

Good Ideas for Replacement

Another supporter, Anne Galante, MD, an ob.gyn who volunteers at the Open Door Clinic of Middlebury, Vt., also did not support full repeal; however, she’s still critical of the law.

“The spirit of covering everybody is good, but in reality it wasn’t good for everybody … People technically have insurance, but they can’t use it.”

Trump has good ideas for replacing the ACA, she said — i.e., including health savings accounts and allowing health insurance companies to sell plans across state lines — and she believes that he won’t let people “die in the streets,” as he’s promised.

She admits, she is “nervous” — “I really hope the new administration doesn’t drop the ball.”

Meanwhile, a few hundred people gathered downtown Friday morning to call for President Trump to end federal cannabis prohibition. Congregating on the sidewalk just to the west of Dupont Circle in Northwest Washington, a group of event organizers with the group DCMJ handed out small joints to anyone who could show proof of being at least 21.

About 11:30 a.m., the protesters marched down 19th Street towards the National Mall. They played music as they walked, arriving peacefully in between the Washington Monument and World War II Memorial.

Several protesters headed for a nearby security checkpoint to get into the Mall, while others stayed outside and listened to the inauguration festivities via a portable speaker organizers brought. Four minutes, 20 seconds into Trump’s speech, most among that crowd of about 100 sparked their lighters and indulged.

Helping the Uninsured

Sen. Bill Cassidy (R-La.) sounded positive about Trump’s inauguration speech, in which he talked about solving the problems of the poor.

Cassidy said he wasn’t disappointed that new president hadn’t mentioned healthcare.

“If you combine his previous statements regarding the need to cover all and take care of those with pre-existing conditions with [today’s speech] about those who have not done well over the past 8 years and you put them together … it shows that I think he’s going to be where most physicians are,” he said in a phone interview. “We want patients to have coverage, and we want it to be meaningful.”

Rep. Andy Harris, MD, (R- Md.) said Trump’s speech was non-partisan. “It was an America-first speech. He was unabashedly America-first on the campaign and I think it struck a chord in the Midwest.”

Harris was also unfazed by the absence of healthcare in Trump’s speech.

“I think he’s going to to roll up his sleeves and begin to take the steps to make sure that American healthcare and health insurance becomes affordable … He’s sent clear signals in the last week that this is one of his top priorities.”

Harris characterized healthcare changes as “reform and replace” rather than repeal-and-replace, noting that Republicans can’t do everything they’d like through the budget reconciliation process.

“Without 60 votes in the Senate you really can’t repeal it… I’m just being a little more technically correct.. The end goal is to put in something that works, so I don’t think that the semantics of it matter.”

‘Repair’ Rather Than ‘Replace’

Harris’s colleague, Rep. Ralph Abraham, MD, (R- La.) took a similar view.

“I would prefer to use the word ‘repair’ rather than ‘replace,’ because we’re going to keep some things. It’s not going to be a complete replacement, but it’s going to be a pretty good overhaul,” he told MedPage Today in a phone interview, noting that preserving access for those with pre-existing conditions and allowing people under 26 to stay on their parents’ insurance plans were two of the “good things.”

Anish Koka, MD, a Philadelphia cardiologist who supported Obama prior to voting for Donald Trump, said he was optimistic about Trump’s healthcare plans. “My general feeling was we were headed on a path that’s going to make it more and more challenging for physicians — especially independent physicians — to survive, since [things like] bundled payment and large integrated care networks have a lot of [requirements] that a lot of solo or small practices don’t have,” he said in a phone interview.

“It is somewhat of a relief to feel that, based on some of the early comments Tom Price has made — certainly at his hearing — there may be relief coming for independent physicians in terms of onerous regulations that are tough to manage.”

As for the ACA, “Whether you call it repeal, or fixing it, something that allows us as physicians to take on patients in a way that’s not untenable; that’s what I’d like,” Koka said. “The vast majority of us want expanded access for patients … the question is, how do we get that? It became increasingly obvious that the ACA and the way they were going about it is not necessarily the best way to go about it.”

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