This week, ACG Portland brought together a panel of health care industry experts and local health care executives to uncover how the election could change health care in America.
Long before the results were in, experts across the country predicted that health care reform would be a major component of the next president’s agenda. Rising premiums, uncertainty about the future of the Affordable Care Act (ACA), and the possible collapse of individual insurance exchanges loomed large in the minds of industry executives and policy makers.
In the weeks leading up to November 8, the results of the presidential battle seemed like a forgone conclusion to many Americans. Then, against the odds, Donald Trump won.
Many of us in the northwest and around the country, regardless of the color of our stripes, are very interested to know how Trump’s presidency will change our world. Uncertainty abounds and very few of us like uncertainty.
The panel of experts took on the task of offering some predictions about what the future might hold in these uncertain times. In case you missed it, here are a few highlights from the lively discussion.
Julie Barnes – Director of Health Care Policy; Cambia Health Solutions, Washington, D.C.
Katherine Kohatsu – Principal Strategy & Health Industries Advisory; PricewaterhouseCoopers, Chicago
Luis Machuca – CEO Enli Health Intelligence, Portland
Dusty Lieb (Moderator) – Principal and Assistant Director, Strategic Investments; Cambia Health Solutions, Portland
What can President-Elect Trump do right away to make good on his promise to dismantle the ACA?
Trump could by Executive Order advise the IRS that it need not enforce the individual mandate.
Though he has the power to do so on Inauguration Day, immigration and international trade may be higher priorities on day-one. Trump likely will look to more comprehensive approaches to his ACA agenda.
It could end up that a judicial process ends Obamacare, not a legislative one.
There are several court cases lined up challenging different aspects of the ACA, including the legality of subsidies. They are vulnerable because Congress did not authorize the requested funding, and subsidies funding was technically misappropriated from other government program accounts. The ACA relies upon subsidies to individual premiums and subsidies in the form of cost sharing reductions to insurance companies. Without subsidies, the individual markets will fail.
We could see two Budget Reconciliation Bills put before Congress, unprecedented in the history of the Budget Reconciliation Act.
House Speaker Paul Ryan has clear sailing for broad changes or repeal with an easy, partisan, supermajority. Senate Majority Leader Mitch McConnell does not enjoy a similar majority. But for certain tax, spending, and debt limit legislation, the Budget Reconciliation Act of 1974 allows for expedited process and only a simple majority. The ACA, with its trillion-dollar budget and taxation features, qualifies. A second challenge to the Medicare Expansion provisions under ACA could be similarly handled.
There are lots of ACA alternatives
The White House will not have a lot of work to do to prepare a replacement proposal. Several significant players have already written alternative plans that are ready to go, notably Paul Ryan’s Better Way.
How big of a problem would ACA repeal be?
More than half of the country’s insured are publicly supported. The employer mandate may not survive.
150 million people are covered under company plans; 50 million are covered by Medicare; 13 million were previously under individual plans and that number has swelled to 70 million under the ACA. The loss of funding or a mechanism for public support, combined with the elimination of the employer mandate, could quickly leave many uninsured.
Where will a replacement or revision take us?
We are in the early innings of what will be a very short game in which employers get out of health care. Employers will start throttling back and will have a head wind.
Large numbers of employers are expected to stop providing health benefits and turn their employees to the individual marketplace.
What will be the biggest thing in health care in the next 10 years that will affect everyone? MACRA. It’s all about the value equation.
Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 — or MACRA —is already a part of the ACA and has tremendous bipartisan support. It passed 92 to 8 in the Senate and 392 to 7 in the house. This level of bipartisan interest virtually assures MACRA’s survival in whatever revisions or replacements happen to the ACA.
Medical professionals only get paid when you are sick and stay sick. We need to incentivize providers financially to heal people so as never to see them again.
The current fee for service model of paying providers for the number of ill patients that appear before them is a huge impediment to cost savings. The trend toward scalable consumerism and value-based reimbursement models will enable implementation of the principles and changes established under MACRA. This approach will be the big step in fixing health care.
Where is there consensus?
Everyone is Interested in lowering cost and improving results.
There is strong bi-partisan support for improved reimbursement models based upon favorable healthcare results and providing greater transparency and a focus on consumerism. By consumerism, the panel was referring to initiatives of cost and service transparency and financial incentive that bring individuals to shop more thoughtfully for value in their health care choices and engender value competition among providers.
There is much in this area of bipartisan agreement that could form the basis of positive reform rather that abrupt repeal with its attendant transitional vacuum if a healthy negotiation can be established.
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