1. 2017 Health Care Policy Preview

2. Elections determine the starting point for policy conversations.

3. Divided Government

4. A Whole New World

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

7. The Affordable Care Act

8. The ACA is not working as well as expected.

9. 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.

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

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

13. 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.

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

17. 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.

18. The ACA is about to undergo a metamorphosis.

19. ‘Repeal and Replace’ is really better described as transition

20. Republicans and ACA Transition
The Role of Insurers
Disruption
Hard Choices

21. Medicare, Medicaid and CHIP

22. 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.

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

24. 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.

25. Pick Your Pace = MACRA Delay

26. Everyone Gets a Trophy

27. MACRA was bipartisan, bicameral passing overwhelmingly.

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

29. Legislators gonna
legislate.

30. 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

31. Prescription Drug Pricing

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

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

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

35. Monsters Abound in Health Care Policy

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

37. Let’s talk about you

38. Happiness is talking health care policy.
Rodney L. Whitlock