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Five experts comment on the next chapter in healthcare policy after demise of ACA repeal bill

By Chris Harrop
October 10, 2017
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Just a few weeks ago, Republicans in Congress were rallying support for a bill to repeal and replace the Patient Protection and Affordable Care Act (ACA), and Health and Human Services Secretary Tom Price, MD, was focusing on awareness for flu season.

A lot has changed since then: The Graham-Cassidy bill was shelved before making it to the Senate floor for a vote, and Price resigned his post after reports about taxpayer-funded travel on private flights.

These events underscore a shift on the healthcare policy front that also includes increasing signs of support for a single-payer healthcare system. A Quinnipiac University poll released Sept. 28 found that about two in three Democratic voters think a single-payer system, featuring expanded Medicare to cover every American’s medical expenses, is a “good idea.” Such a plan has been embraced by several top Democrats in the U.S. Senate, including Kamala Harris of California and Elizabeth Warren of Massachusetts.

These changes may be uncharted territory for observers who expected an ACA repeal and a trend toward less government involvement in the healthcare industry with a Republican president and a Republican majority in Congress following the 2016 election.

“Nobody saw this coming,” said John McDonough, professor, practice of public health, Harvard T.H. Chan School of Public Health, Boston. McDonough was one of five health policy experts to talk on the future of the ACA during a Sept. 27 forum moderated by Reuters correspondent Caroline Humer. “You’d like to have some finality one way or another in terms of repeal and replace, and it looks like we’re not going to have that.”

Shella Burke, chair, government relations and public policy group, Baker Donelson, Washington, D.C., and adjunct lecturer in public policy, Harvard Kennedy School, Cambridge, Mass., said that after the collapse of the Graham-Cassidy bill, other competing interests will occupy Congress for the short and long terms.

“Healthcare is not the only issue that is in play here,” Burke said, noting that appropriations for short-term demands such as disaster relief will complicate any further major attempts at repealing the ACA. Instead, Burke thinks that insurance market stabilization efforts for the next one to two years will come to the forefront, with longer-term focus on topics such as essential health benefits.

Robert E. Moffit, PhD, senior fellow, The Heritage Foundation Center for Health Policy Studies, Washington, D.C., noted that he does think healthcare will remain a hot topic even while many in the congressional majority look to move onto tax reform and other issues, with premium increases and decreases in competition among insurers in many counties across the country likely spurring action.

“[Congress] cannot ignore this, this is on their watch,” Moffit said, adding that he believes the compromise bill offered by U.S. Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., may find new life as a means for addressing cost-sharing subsidies and market stabilization — but that nothing is certain in the current political climate.

“None of this is really predictable, though,” McDonough said. “There is … a totally predictable unpredictability of Donald Trump.” That unpredictability now has many Democrats, once faced with the prospect of ACA repeal, now talking about a single-payer health system. McDonough does not see single-payer as a winning issue for Democrats but said he welcomes the debate “because it’s going to give us an opportunity to really clear the air on where we want to go as a country and what kind of healthcare system we want to have.”

Robert Blendon, professor of health policy and political analysis, Harvard T.H. Chan School of Public Health and Harvard Kennedy School, discussed his own polling work and how it signals that while people may not be ardent supporters of the ACA, their views on its effects are pronounced.

“When you talk about public opinion, it never corresponds to the front of the newspaper … what really changed in the United States in the last [few] years is a commitment to not dropping the 30 million people from coverage,” Blendon said, referring to estimates of insurance coverage losses under recent failed ACA repeal bills. “We are likely to keep having a debate about an ‘it,’ [but] there is no agreement what that ‘it’ should look like, but there will be a lot of people who want an alternative to the ACA.”

Blendon cited polling showing consistent division regarding support for the ACA, but that a “historic” change was seen when respondents were asked about the federal role in healthcare without referring specifically to the ACA: the percentage of people who said the federal government should be responsible for health coverage rose from 42% in 2013 to 60% in 2017. “Over a short period of years, the minority of Americans became the majority, basically saying that you can’t take coverage away from people who have it,” Blendon said.

But even while polling suggests public opinion has shifted, Lanhee Chen, research fellow, Hoover Institution, and director, domestic policy studies, Stanford University, Calif., said that common ground on healthcare policy still will be difficult to find.

“I think that what this process illustrated … is just how much division there is — within even the conservative movement, the Republican Party — on issues of healthcare,” Chen said. “For seven years it was very easy for Republicans to simply say, ‘we want to repeal and replace [the ACA],’ without really getting into what that meant. And once we got up in this process, what we realized was how difficult it was to square the circle between Ted Cruz and Mike Lee on one hand, and Susan Collins on the other. … There was not one bill that was going to satisfy all those players.”

Learn more

Anders Gilberg, senior vice president, MGMA Government Affairs, will lead a general session Oct. 11, “MGMA’s A View From Washington,” at the MGMA 2017 Annual Conference on the shift in healthcare policy since the 2016 election and the trajectory of the political and regulatory environment for medical practices.

Chris Harrop, senior editorial manager, Publications, MGMA

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