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2017 Health Care Policy Preview
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Elections determine the starting point for policy conversations.
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Divided Government
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A Whole New World
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For 2017, there are three major health care policy areas.
The Affordable Care Act (ACA) Medicare, Medicaid, and CHIP Prescription Drug Pricing
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The Affordable Care Act
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The ACA is not working as well as expected.
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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.
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Competition is shrinking
Competition is shrinking. Last year only 7% of counties had only one insurer. Next year, it is projected to be 31%.
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The ACA has two problems.
One is about participants. The other is about costs.
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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.
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The second problem the ACA faces is that health care is expensive for the consumer.
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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.
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The ACA is about to undergo a metamorphosis.
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‘Repeal and Replace’ is really better described as transition
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Republicans and ACA Transition
The Role of Insurers Disruption Hard Choices
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Medicare, Medicaid and CHIP
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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.
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MACRA creates significant, unified data reporting requirements for providers. There will be financial winners and losers based on the data reporting.
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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.
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Pick Your Pace = MACRA Delay
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Everyone Gets a Trophy
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MACRA was bipartisan, bicameral passing overwhelmingly.
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In 2017, Congress must consider therapy caps and CHIP and a handful of other extenders.
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Legislators gonna legislate.
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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
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Prescription Drug Pricing
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Drug pricing is a hot political issue being talked about on both sides of the aisle
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You can’t spend all of 2016 talking drug pricing and claim amnesia on Nov 9th.
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The user fee acts will be on the table in 2017.
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Monsters Abound in Health Care Policy
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Downward cost pressure on all health care stakeholders remains in effect for 2017
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Let’s talk about you
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Happiness is talking health care policy.
Rodney L. Whitlock
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