(Last Updated On: April 1, 2017)

Who are the players that will take on the change from Obamacare to Trumpcare?  Before is an outline of all the players that come to mind.  In some cases there is a short description.

When there are other players that need to be added this blog will be revised.  If new people enter the picture we’ll try to add those individuals.

The Governments

Federal Government

The Executive Branch

The President – Donald J Trump    President Trump

Yes, we start off with Trump, he’s had other matter on his plate for the first couple of weeks but its still a major item on his plate.

HHS – Secretary Tom Price   Secretary Tom Price

Before he was a Congressman he was a successful orthopedic surgeon for many years.  As a Congressional Representative from Georgia he was Pro-Life, Pro Gun, classic Southern Conservative.

We’ll do a separate blog post on the Secretary Price and he past legislative efforts involving healthcare, like Empowering Patients First Act.

If Dr. Ben Carson become Secretary of HUD we’ll have two Doctors in the Trump cabinet, that’s interesting.

Centers of Medicare and Medicaid Services (CMS)     question head of CMS

This is the agency that gets doctors paid for Medicare and Medicaid.  The present administrator is the acting head.

Elected vs Not Elected Officials

Really, Elected Appointees come and go but the bureaucrats are there until they retire. Who is in charge of CMS on a day-to-day basis will have a lot to do with when and how doctors are going to get paid.  This is especially true of the next year of two.

The Legislative Branch

The Senate

Majority Leader McConnell   

So the Senator worked the Senate parliamentary procedure to cut off the filibuster by the Democrats so Obamacare can be repealed.  That’s only the procedure, not the actual act of taking the funds away.  But again that was almost a month ago.

Chairman Lamar    Lamar Adexander

We’ve already mentioned that Senator Lamar Alexander has his toe in the water when it comes to Obamacare.  He wants to adjust it, not throw it away.

The House

Speaker Ryan    Speaker Paul Ryan
Speaker Ryan’s plan is called The Patients’ Choice Act, which is designed to ensures universal, affordable health care for all Americans. “Under The Patients’ Choice Act, patients and doctors would control their health care decisions – not insurance companies and federal government bureaucrats”, so says the Speaker.  But this is from 2009,
Chairman ???

The are a number of committees that have their hand in the Obamacare pie on the House.  Plus the committees are larger and/or more specialized.

But there’s a lot more concern at the House level about a radical repeat of the law.  Here’s another Congressman’s quote:

“I’m much more concerned about the content than the timing,” said Rep. Tom MacArthur (R-N.J.), a former insurance executive who voted no

State Governments

Important to realize that the States have as much to do with the major health programs.  Sometimes these programs have serious cross-talk with the carriers.  For example Blue Cross/Blue Shield is the prime contractor in New York State for Medicare/Medicaid.

Of course there’s the fact that many of Governors opted out of the ACA and how that reduced the pool of people that could have added critical mass to the number of the insured

K Street – The Lobbyists

There are lobbyists for the Insurance Carriers, Pharmaceuticals, Device Manufacturers just waiting in the wing to craft the actual legislation that is created.

It these special interest groups that tend to write the initial draft of most bills, not Congressional staff. 

The Public

Seniors/AARP         AARP logo

Look the subject line from the email I JUST GOT:

Jxxxxx, Join the Fight: Tell Congress to Protect Medicare

Need we say more; Seniors are going to be looking over any changes that are made to the healthcare system.  Seniors did vote for President Trump but they are very suspicious of both Democrats and Republicans

The Doctors

Can the new administration make things any easier for physicians, in particular small practices.  Is it even possible for the small practice to continue to thrive?


There are 100’s of associations for physicians to work with but the AMA is the biggest by far.  They will be working with and sometime working against the insurance companies.


As long as the healthcare system is centered on Employers it will favor large companies and make it difficult for people to switch job.  Taking your healthcare insurance with you is becoming more and more of an issue as freelancing becomes the norm in the economy.

Is the best that we can do in this economy is COBRA insurance?

Do most people remember that we ended up with an employer based healthcare system by mistake?  It is a remnant of 1930’s depression based marketing and then workforce shortages sealing the deal during  WWII.

But if its a bad habit its one that’s going to be hard to break.

The Media

Is the media capable of covering healthcare?  Will we end up with with another round of Death Panels or/and misstatements like You can keep your doctor.  Or on the other end that Medicare will cause the US to become a socialist dictatorship? 

Can the healthcare’s own trade press add to the discussion or the confusion.

Who are the Players – The Ones that Really Count

It’s the Insurance and Pharmaceutical Companies that are the gatekeepers when you objectively look at the chess board.


This post will be revised as more player fall in place.  Unlike a game of chess new players often come into the picture, and old players fall away.