September 30, 2020
Election 2020…What happened to healthcare?
The election is looming. The first debate was a debacle. There’s so much uncertainty, and yet healthcare leaders need to prepare their organizations for, well, whatever it is that’s coming.
We pride ourselves in looking around corners here at Jarrard Inc., but even we aren’t 100% sure where we’ll all end up. Still, we’ve got a lot of thoughts on the types of conversations that will be taking place around the election and healthcare. That includes some of the hotspots that will erupt but, maybe more importantly, areas where providers could temper their expectations – things aren’t going to happen overnight. (Probably.)
We got our in-house political junkies together to riff on what’s going on. Here, we’ve taken some highlights from that roundtable discussion. The conversation was moderated by our CEO David Jarrard. Joining him were vice president in our Regional Practice Justin Gibbs, senior vice president in our National Practice Tim Stewart, and partner and COO Kevin Phillips.
In a normal year, there would be a lot of discussion about healthcare. Does anyone really care this year?
Justin Gibbs: The short answer is no. Nobody’s diving into the policy weeds of how care is going to be paid for what it’s going to look like in the future. The president is not a policy heavy kind of guy and given Joe Biden the luxury of not having to be a policy heavy guy.
So it’s no surprise that the outline for the first presidential debate included COVID-19 and the economy, but no mention of healthcare?
Kevin Phillips: Kaiser Family Foundation did a poll a couple of weeks ago that rated the most important issues for voters in this cycle. Healthcare came in fifth – and that separated out COVID-19, which came in second behind economy. In contrast, healthcare was the number one issue on voters’ minds in February. And the percentage of Republicans who say that the repeal of the ACA is very important has dropped from around 30 percent in 2016 to five percent today.
Why has one of the hottest issues of the past decade suddenly disappeared?
Kevin Phillips: Civil unrest, racial justice and the economy jumped into the top spots. They’re dominating. Even COVID-19 is starting to decline.
Tim Stewart: I’m not sure it says anything about healthcare. I think healthcare has probably stayed the same and it just underscores the seriousness of everything else happening across society.
So then where exactly does healthcare fit into the election?
Kevin Phillips: Two things: With Kamala Harris on the ticket Medicare for All could come back up. And with the passing of Justice Ginsburg and the upcoming hearing for Texas v California, repeal of the individual mandate could return as a political issue.
Tim Stewart: If Biden wins, it’s not going to be his first priority. It wouldn’t be even in a world where we didn’t have COVID-19. It would be foolish for a Democratic president, even with a Democratic Congress, to pursue a major overhaul of healthcare as their first priority, because it would end up being their only priority.
Justin Gibbs: If Biden is elected and the Democrats keep the House and take the Senate, it’s plausible that Biden will be pushed to push towards Medicare for All. I agree that it’s not a first priority because we’ve got to get the economy back on track and that’s where I would spend my political capital, but the left wing of the party is going to be pushing hard for this. It took a unified government to get the ACA passed 10 years ago. It’s going to take the same now and they won’t want to miss their chance.
If you’re running a healthcare organization and you understand that most people aren’t thinking about healthcare the way you’re thinking about it, but you’re strapped for funds and you’re wondering what the future is going to be…What do you do? What do you say today?
Justin Gibbs: Providers have to enter the fray but in a way that rises above politics. They need to talk about their mission and delivering on that mission for their employees, for their patients, for the communities that they serve. They shouldn’t get into specifics of a particular plan. Keep in mind Obama was sworn in January 2009 and the Affordable Care Act didn’t become law until March of 2010. So regardless of who the next president it is, it’s going to be a while before there are any big sweeping changes.
Tim Stewart: Take it out of national politics. The bill is going to come due on a lot of this year starting next year. What does this look like when patients are receiving literal bills for COVID-19 tests they thought were covered care? And then all of the care that people have put off this year. It seems like somebody is going to get blamed for the costs that individuals and groups are going to incur.
Justin Gibbs: The big insurance companies, all posted record gains over the course of the last few financial quarters. At a time when the economy is struggling, when people are struggling, and out of work, it doesn’t pass the smell test for insurance companies to be making the amount of money they are making and then sticking patients with huge bills. That’s an important narrative for hospitals to continue.
It’s also important to continue outreach to your state and federal legislative delegations to continue the conversation about all of these bills coming due – including the advance payment for Medicare. If we’re looking for a bipartisan issue here, Democrats and Republicans have both been working to make sure that hospitals have the resources that they need to continue.
Where else does outreach need to happen?
Justin Gibbs: Leaders of provider organizations need to be having concerted conversations with their employees about funding because those employees represent a huge voter block and nothing speaks to elected leaders like a base of support from the people who keep them or kick them out of office. They also need to have that conversation with the media as much as they can.
Provider employees are typically pretty diverse – in numerous ways – how do you have those conversations appropriately and effectively?
Justin Gibbs: There doesn’t need to be anything ideological about it. It’s straightforward: This is the revenue that was forfeited to prepare for and provide care during the pandemic, this is the assistance that we’ve gotten to date and here’s the gap. We’re doing everything we can to absorb that, and in the future, we may be looking to you for help advocating for our organization.
David Jarrard: So you activate that support and you get to turn it into something for it to become a political force that will get you more financial support.