Michael Kinsley–a truly brilliant commentator–once defined a gaffe as when a politician tells the truth. Former President Bill Clinton committed just that on Monday when he said this about the ACA:
“So you’ve got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.”
He clarified his remarks on Tuesday, when he said Obamacare had done “a world of good,” despite its problems. And it has. But like all enormous programs–government or private–it needs testing and reform. And the GOP-controlled Congress has refused to consider anything except its demand for repeal.
We will be discussing the origin and possible future of the ACA in Thursday’s class. Before we meet, read this piece in this week’s Times on some of the changes the “ailing” ACA may need to make to survive.
Yesterday I had the pleasure of attending “NIHCM Foundation’s 2016 Capitol Hill Briefing, The Future of Health Care in America” held at the House of Representatives. Naturally a briefing on “The Future of Health Care in America” would illicit conversation about the future, however the interesting election cycle that we are currently enduring really shaped the way the conversation in the Cannon Caucus Room went yesterday. Partisan discussion about what is best for our country went differently than you would expect as all the speakers presented similar points and shared a similar level of uncertainty. The speakers were tasked with addressing two concerns:
– What will Congress and the new administration have to face in 2017?
– Will a fee-for-service system be replaced by a value-based system?
1. What will Congress and the new administration have to face in 2017?
The speakers all agreed that there were Four Policy Priorities
– Improving the healthcare exchange marketplaces (comprehensiveness and transparency)
– Mitigating hospital market power
(This particular topic was extremely interesting as the speakers made note that hospitals were not patient centric, An example given was that typically the most convenient parking near a hospital is reserved for “MD’s only” while those who are ill actually need their distance to quality care to be shortened)
– Designing alternate payment methods
– Increasing the affordability of healthcare
2. Will a fee-for-service system be replaced by a value-based system?
The speakers were less sure if this would occur and maintained that it strongly depended on the election outcome, however all stated that it would be best if the current fee-for-service system was replaced. Ways that they believe a value-base system could be established were to.
– Extend reinsurance (Reimburse insurers for a portion of the costs spent on high risk patients to keep individual premiums low)
– Fund risk corridors (Provide federal funds to those insurers who spend more than budgeted on costs to keep individual premiums low)
– Establish 4:1 age bands and increase subsidies for older people (Currently 3:1 in place stating that if a 21-year-old woman’s premium is $200 a month for a particular health plan, a 64-year-old woman’s premium for that same health plan cannot be more than $600 a month ($200 x 3 = $600), The speakers endorse raising the premium for older individuals )
– Create larger exchanges (multi-state) to make exchange navigation simpler and care consistent across regions.
– Increase mandate policy (Increasing the costs of being uninsured so that more people enroll and premiums decrease)
– Creating “Patient Obsessed” platforms: Treating patients in the same manner that Amazon and Starbucks does by providing patients with subsidies as well as consistent quality care no matter where they go.
The last slide of the session presented by Uwe E. Reinhardt, PhD, James Madison Professor of Political Economy, Woodrow Wilson School, Princeton University simply stated and showed that he could not predict the future and until then he would be wearing…