2017 Health Care Policy Preview

Elections determine the starting point for policy conversations.

Divided Government

A Whole New World

For 2017, there are three major health care policy areas. The Affordable Care Act (ACA) Medicare, Medicaid, and CHIP Prescription Drug Pricing

The Affordable Care Act

The ACA is not working as well as expected.

The ACA is not working as well as expected. That is a fact. In 2013, 24 million Americans were predicted to have joined the exchanges by now. There are half of that in the exchanges now.

Competition is shrinking Competition is shrinking. Last year only 7% of counties had only one insurer. Next year, it is projected to be 31%.

The ACA has two problems. One is about participants. The other is about costs.

The first problem is that the pool is sicker than expected which is a function of lower than expected participation rates by younger, healthier people.

The second problem the ACA faces is that health care is expensive for the consumer.

The share of health care cost paid for by the government versus the share of health care costs paid for by the beneficiary is a policy choice.

The ACA is about to undergo a metamorphosis.

‘Repeal and Replace’ is really better described as transition

Republicans and ACA Transition The Role of Insurers Disruption Hard Choices

Medicare, Medicaid and CHIP

In 2015, Congress finally replaced the fundamentally flawed SGR payment policy in the Medicare and CHIP Reauthorization Act, now commonly referred to as MACRA. MACRA is a fundamental shift in Medicare policy. It’s not simply that it ended the flawed SGR, but it is that it moved the Medicare program away from fee-for-service.

MACRA creates significant, unified data reporting requirements for providers. There will be financial winners and losers based on the data reporting.

The House of Medicine hated the SGR The House of Medicine hated the SGR. That doesn’t mean they are in love with the replacement.

Pick Your Pace = MACRA Delay

Everyone Gets a Trophy

MACRA was bipartisan, bicameral passing overwhelmingly.

In 2017, Congress must consider therapy caps and CHIP and a handful of other extenders.

Legislators gonna legislate.

VERY BIG BITE Entitlement Reform Republicans would like to move Medicare to a premium support model. Republicans would like to move Medicaid to a block grant or a per capita cap model. ACA replacement and entitlement reform is one … VERY BIG BITE

Prescription Drug Pricing

Drug pricing is a hot political issue being talked about on both sides of the aisle

You can’t spend all of 2016 talking drug pricing and claim amnesia on Nov 9th.

The user fee acts will be on the table in 2017.

Monsters Abound in Health Care Policy

Downward cost pressure on all health care stakeholders remains in effect for 2017

Let’s talk about you

Happiness is talking health care policy. Rodney L. Whitlock rlwhitlock@mlstrategies.com