The Washington Report is provided courtesy of Mara Baer
Earlier this week I had the opportunity to do a presentation to a large group of employers and innovators on the political outlook and its impact on the future health care agenda. I suggested to the audience that we look into a crystal ball and try to see the future. Perhaps I should have suggested we rely on the Magic 8 ball. The feedback from the audience was that this election brings great uncertainty and angst (It is decidedly so). Being prepared for a range of scenarios can mitigate some of these concerns and is something that large health care entities are doing now.
Cost increases in the individual market have employers on edge about potential spillover effect to their markets. Innovators are concerned that new payment models aren’t moving quickly enough to meet the pace of the digital health boom. These issues are also top of mind for policymakers as they sprint to November.
While we can’t be certain what the political environment will bring after this election season ends (reply hazy try again), there are some expectations health care market players and business owners should consider when planning for the future:
Continued divided government is likely (Ask again, later). Most Washington insiders anticipate the House will remain controlled by Republicans and that the Senate is in reach of Democrats. The party that runs the Senate will hold the narrowest of margins, requiring consensus to move legislation. Irrespective of who runs the White House, divided government should be anticipated. This will result in incremental reform on health care so do not expect sweeping changes to the ACA.
Market forces will drive policy action (Without a doubt). Today’s market forces drive next year’s positioning on policy. Key trends policymakers are watching include: exchange withdrawals resulting in 1/3rd of rating regions having only one choice of carrier, large rate increases on the individual market and related trends towards self-funding by small employers, escalating drug costs, and market consolidations.
Action on ACA will be incremental (Signs point to “yes”).
Both Presidential candidates have outlined their health policy platforms – Hillary Clinton with specificity, Donald Trump more broadly. Secretary Clinton hopes to build on ACA’s successes and make improvements where needed and has the backing of her party by most accounts. Mr. Trump has promised to push towards repeal of ACA but many Republicans are shifting towards incremental steps.
Should Democrats win the White House and regain the Senate, expect significant action to boost young and healthy enrollments through new subsidies and relief from out-of-pocket costs. Enhancing risk programs in support of exchange carriers will be a priority and a public insurance option will also have its place in debate.
Should Hillary Clinton become President and the Congress remain Republican controlled, we should anticipate little consensus on ACA. Congress will push to eliminate the employer and individual mandates but will have no traction at the White House. Clinton will use her regulatory authority to improve the ACA. Republicans will be calling the Administration to testify – exerting its oversight authority. For example, expect hearings on CMS’ Innovation Center where most payment and delivery reform activities are housed.
A Republican sweep provides less certainty given lack of detail in the Presidential candidate’s health care proposal. The best place to start evaluating the possibilities is the Republican White Paper released earlier this year. In addition to mandate repeals, cross state lines and advancing consumer-directed plans are priorities.
Both parties have expressed interest in addressing the excise tax on high-cost employer plans and the health insurer tax. How incrementally these are addressed depends on a variety of factors but I would anticipate delays rather than repeals (As I see it, yes).
Legislative vehicles are essential for policy action (Concentrate and ask again).
While we can anticipate possible scenarios for health care activity based on the November outcome, any action will rely on larger legislative vehicles moving through Congress that have some tie to the reforms that are sought. Some potential vehicles are the budget/debt ceiling, tax reform, and reauthorization of FDA’s user fee programs.
Like the Magic 8 ball’s answer key icosahedron shape (having 20 sides), the policy environment can play out in a variety of scenarios. The question is- would your organization prefer to sit out and wait to see where the future takes us or use strategy tools to anticipate what is most likely and develop approaches to excel? It is certain that pursuing the latter in support for your business goals is the favorable approach. Can you meet your goals without it? – Don’t count on it.