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The 2024 presidential election has ushered in Donald Trump’s return to the White House. With it, questions arise about the future of health care policy and implications for the ambulatory surgery center (ASC) industry.

“President Trump was president for four years, so it’s not like we’re walking into this completely blind,” J. Blake Peart, managing director at health care advisory firm Vertess, told ASC News. 

The Affordable Care Act (ACA) remains a critical issue, Peart said. During his first term, Trump sought to dismantle the ACA, but he did not present an alternative plan. 

Currently, government subsidies are supporting enrollment in ACA insurance marketplaces for millions of people. If the subsidies expire as planned in 2025 and beyond, the ASC industry could see changes in patient volumes and payer mixes. 

“I think the bigger push is going to be: Are they going to go after the Affordable Health Care Act like he did the first term, which will obviously have a lot of effects on payers and the number of payers,” Peart said.

The America First Policy Institute and Heritage Foundation’s “Project 2025” have proposed rolling back protections under the ACA, which could impact insurance coverage for millions. 

“Subsidies would almost certainly die under unified Republican control,” health care policy researchers wrote in JAMA just before the election.

Insurance instability will create challenges for ASCs, forcing them to adapt to fluctuating patient coverage, Peart said, as Trump pushes private health insurance to become a more dominant force. 

“We all know, even though you’re dealing with some private insurance companies, it’s all government-backed and supported,” he said. “So, I think there will be more flexibility in trying to get better contracts with private payers. And you’ll probably see more lucrative deals.”

At the same time, potential leadership changes at the Department of Health and Human Services (HHS), particularly the appointment of Robert F. Kennedy Jr. as its head, will be detrimental to health care access, Scott Kulstad, executive fellow at the University of St. Thomas Opus College of Business, told ASC News. Kulstad is also CEO of St. Paul Eye Clinic.

“I believe we will see HHS more focused on limiting the FDA’s role and gutting other regulatory positions than affirmatively advocating for greater access to safe, high quality, effective, efficient, equitable access to care for all Americans,” Kulstad said.

Funding healthcare will not be among Trump’s highest priorities, Kulstad added.

“That said, it may be interesting to see if he adopts any health policy positions that address the concerns of the electorate that moved from the Biden administration to Trump in this cycle,” he said. “These families need access to care that many are finding unaffordable and inaccessible.”   

Eric Evans, CEO of Surgery Partners, Inc., said during a recent earnings call that the company, which operates a large portion of ASCs in the United States, will be watching whether the Trump administration will eliminate the inpatient-only procedure list.

“We’ll see where that goes,” he said. 

Regulation relaxation and the M&A landscape

The regulatory environment will likely become more relaxed under a second Trump term, Kulstad said.

“I imagine we will see less antitrust enforcement,” he said, which could drive continued consolidation in the ASC sector. He is hardly alone in making this prediction. Saum Sutaria, CEO of Tenet Healthcare Corporation (NYSE: THC), recently said that he expects the antitrust environment to become more favorable for healthcare consolidation. Tenet’s ASC arm, United Surgical Partners International (USPI), operates more than 540 facilities nationwide.

Other more relaxed regulatory frameworks, such as Stark Law exceptions, may enable more flexibility in physician ownership and partnerships. 

“Ironically, when the Supreme Court struck down Chevron deference to the agencies under the executive branch, it may have also weakened the executive branch’s ability to implement policy through its rulemaking authority,” he said. “That may be an interesting dynamic to watch play out, too.”  

Peart echoed these sentiments, predicting a surge in mergers and acquisitions (M&A). 

Peart predicted an increase in private equity acquisitions, driven by lower interest rates and a favorable economic environment under the Trump administration. 

“Private equity, I think, has a trillion dollars in dry powder they can use,” he said.

After years of hesitancy, partly due to post-COVID policy uncertainties, private equity players now have more clarity and confidence to move forward aggressively, he said. 

“We saw what the Dow did [on election day], going up 1,000 points,” he said. “I don’t think it’s just because Trump got in. It’s because now we have a path, and now we know what’s going to happen.”

Still, while consolidation accelerates, independent ASCs may find opportunities to align with like-minded peers, Woodrow M. Moore, founder of the Texas ASC Society, told ASC News. 

“It is good to experience the continuity of government and the apparent mandate for allowing independent, free-market forces to work,” he said. “Such is the opportunity for the nation’s estimated 60% of ASCs which remain independent.”

The common narrative is changing in the ASC sector, he added. 

“No longer is private equity and health system control the only option available to independent ASC owners,” Moore said. “An entrepreneurial middle-ground, a cooperative of sorts is being cultivated.” 

Supply chain dynamics 

Supply chain disruptions and cost management also remain critical concerns. Trump’s focus on domestic manufacturing might benefit ASCs in the long term; however, the transition could increase short-term costs with potential shifts in tariffs and trade policies.

“A lot of what we get is from China, Vietnam, Taiwan, Japan and Germany,”  Peart said, referring to various medical supplies. “Some of these areas are more friendly than others, and we have good relationships with them.”

Yet under a Trump administration, there may be a push to do things more domestically, which could lead to mixed results, he said. 

“Again, why do we buy it overseas?” he said. “Because it’s cheaper.”

Still, energy costs will likely decrease under Trump’s administration, which could lower operational expenses for domestic manufacturers, Peart said. This could stabilize supply chains and reduce reliance on imports. 

The list of potential changes under a Trump administration goes on: for example, Trump’s preference for states’ rights over centralized federal control could lead to varied healthcare policies across states, Peart said. This approach may grant ASCs more flexibility in negotiating contracts but could also create disparities based on location.

While predicting how the incoming administration will drive change across such a wide range of issues is impossible, ASC operators are reading the tea leaves and devising strategies accordingly, as the countdown to inauguration day is on.