High Stakes

LHC Takes DC: Healthcare Insights from Inside the Beltway

Leadership Health Care's D.C. Delegation Hears Insiders' Take on Health Policy

With Winter Storm Stella bearing down on our nation’s capital, the Nashville Health Care Council’s Leadership Health Care delegation gathered for a two-day, bi-partisan session to suss out the current three Rs of healthcare – repeal, replace and reconcile.

The gathering was punctuated by CBO’s proclamation that the proposed American Health Care Act (ACHA) would result in 14 million more Americans being uninsured by 2018. Upon hearing that news, Bank of America analyst Kevin Fischbeck quipped from the panel: “Tomorrow will be a pretty bad day in provider land.”

Discussions were robust and diverse, leading to numerous insightful takeaways to guide healthcare thinking in the coming months:

Medicaid’s still the industry’s hot potato.

Presenters and delegates were in accord that Medicaid is the most vulnerable piece of the AHCA, and few think that the bill gets it right. Some think it goes too far in rolling back the ACA’s expansion, while others feel that more cuts are needed to control costs and transition more control to the states. Moral of the story? Medicaid – and how states react to any changes – will continue to monopolize the healthcare conversation, and the biggest challenge for the White House, Senate and House is keeping the support of their own GOP members.

The name of the game.

A recent poll from Morning Consult showed that 17% of the U.S. thought Obamacare and the ACA were two different things. It has been argued that the propensity to repeal Obamacare had just as much to do with what it was called as it did with what was in the plan. Especially as Congressional Republicans are calling the AHCA “Obamacare Lite”, the question remains –  were people more upset with Obama or the Care?

Is 2017 a 1995 redux?

As we all know, stakeholders and their opinions also matter. In the ‘90’s, Clintoncare was crafted absent any input from outside the Executive Branch. It failed. In complete contrast, Obamacare was orchestrated from Capitol Hill, with a president keen on bringing constituencies along to develop it. It passed. The jury is still out on AHCA, but thus far, third-parties have not been a part of it and have come out against it. And as patients embrace their roles as consumers and direct communication with leaders, this input and engagement is more critical than ever. Speaking of…..

Consumerism is here to stay.

Patients are wrapping their arms around this new role, and three drivers are making a particularly strong impact. First, high-deductible plans have given consumers more of an understanding of what care really costs versus just knowledge of their copay. Second, convenience has sparked the proliferation of urgent care centers and telemedicine as people want a say in when and where they get their healthcare and how much it costs. Third, transparency is starting to emerge regarding the cost of pharma, from Epi-Pens to other specialty drugs.

Collaborate and be vocal.

What’s the secret to successful healthcare policy? According to Republican and Democratic officials from Tennessee, it’s bipartisanship. While Rep. Jim Cooper (D-TN), known for his commitment to reach across the aisle, sometimes calls it “painful work”, former Senator Bill Frist (R-TN) reinforced that “Nothing will be sustained in healthcare unless it’s bipartisan.” They also encouraged delegates to stand up for what they believe in and to keep asking questions. Cooper reminded attendees that they have so much more power than they realize, adding, “If you hate something like poison, don’t drink it like Kool-Aid.”

Uncertainty reigns supreme.

According to Thomas Cassels from The Advisory Board, “The uncertainty this bill supercharges is more than providers are willing to stomach.” Of course, we’re seeing initial reports from the CBO, but continued evolution is the name of the game. Tennessee representative and Budget Committee Chairwoman Diane Black (R-TN) summed it up: “Whatever you see today, don’t memorize it. Because things are going to change.”

 

Note: Taylor Stanford co-authored this blog.

 

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