After a long summer hiatus, Saturday Night Live aired with new episodes over the weekend. And, they absolutely crushed it with this must-see sketch on the first Presidential debate.
For the first time in a while, we all got a much needed laugh about the 2016 election. But all joking aside, the election poses some interesting prospects for the future of healthcare, creating both challenges and opportunities for improvement.
Here are some givens.
In the event that you were hoping for a wholesale stop and restart on the Affordable Care Act (ACA), let me be the first to burst your bubble: No matter who takes the White House, a wholesale repeal isn’t going to happen.
Second, the movement from pay-for-volume toward pay-for-value will continue, although the pace of change may speed up under the Democrats or slow down slightly under Republicans.
Now on to the unknowns.
There are three potential election outcomes. Each have consequences for the ACA. While complete repeal is unlikely, following are some potential alterations, depending on the election outcome.
The sum and substance of the ACA will remain intact, with few major changes. But here are some changes that could happen:
- Additional health insurer regulations on the exchanges to allow for more apples-to-apples comparisons between plans, the creation of tax deductible health spending accounts, added subsidies to cover out-of-pocket costs and an option to buy into the Medicare program as early as age 55.
- Possible new state incentives to expand Medicaid for non-expansion states.
- And, given the headlines and Hillary Clinton’s public statements, the potential for more aggressive drug price oversight, including legislation requiring more price transparency, and potential for price controls.
There will be a period of consensus building before a clear path emerges. For one, the party is not united behind a single solution on health reform. For another, a lot of Americans have seen some benefits from the ACA, making it a challenging prospect to take away. A few fairly clear Republican agenda items, include:
- Expansion of Medicare Advantage and health savings accounts, shifting more control to the states to either keep or set up alternatives to the exchanges; as well as Medicaid expansion but with greater flexibility granted to the states by the federal government to include higher co-pays and work requirements for recipients.
- Potentially reduced coverage subsidies and repeal of the employer mandate.
- Repeal or changes to some of the ACA’s taxes, such as the Cadillac, device and other taxes, but only if the party can rally around offsets.
This is where I am placing my bets. There will be continuing standoff on major changes to the ACA. At the same time, Congress and the Administration will act to find solutions to some of the biggest problems with the law: the lack of competition and cost increases among exchange plans, uneven expansion of Medicaid, and increasing costs of healthcare overall.
One thing that exists under any scenario is the high level of government deficit and debt. With the aging population, huge expenditures by government in healthcare programs and rising healthcare spending, efforts to move our system from volume to value will continue, including all of the payment and delivery system changes that have been underway for the past 15 years.
These outlooks are the tea leaves as I read them, but I am interested to hear more about what you think! Share your thoughts in the comments and let me know how you see both your local and national elections shaping up, and how you think the results will change healthcare in your community.