Eleven Things to Know About Healthcare in the Midterm Elections

With healthcare being a key issue in the midterm elections, here are 11 things healthcare executives should keep in mind.

American voters will soon participate in the 2018 midterm elections and one of the most-if not the most-important issue for them is healthcare.

According to a survey of 1,500 Americans conducted by HRI in September 2018, 59% of respondents said healthcare was a very important issue for them in the elections, followed by Social Security and Medicare. Healthcare ranked as the first or second priority for Americans surveyed by HRI across age, race, and geographic region.

“Healthcare in the midterms is important for healthcare executives to watch because while most believe ACA needs to be altered, the question is how,” says Scott Olson, CEO of addiction treatment center Pathway Healthcare. “There are benefits and downsides with ACA, and changes are not easy.”   

Peter Bonis, MD, chief medical officer of clinical effectiveness at Wolters Kluwer Health, shares a similar viewpoint.

“The ACA has been weakened under the current administration but neither party has presented a comprehensive legislative approach that is realistically capable of tackling critical issues, particularly affordability,” Bonis says.

With healthcare being a key issue in the midterm elections, here are 11 things healthcare executives should keep in mind:

1. The single-payer issue will continue to be a heated topic on both the right and the left. “A single-payer system isn’t the solution to rising costs, lack of transparency, and sub-optimal outcomes; studies highlight the exceptional market risks of single-payer proposals,” says Rita Numerof, PhD, president of healthcare consulting firm Numerof & Associates. At the same time, she says, if industry stakeholders put payment ahead of outcomes they will add to voters’ frustrations with the current system. “Politicians will be sure to capitalize on these frustrations, in whatever way most closely aligns with their own platform,” she says.

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2. There is growing awareness of and support for protection of pre-existing conditions. “This might mean that short-term plans in the individual market will not do as well as forecasted, since more people might view them as an inferior product,” says Katherine Hempstead, PhD, senior policy advisor, the Robert Wood Johnson Foundation. “All candidates are trying to show support for pre-existing conditions, with varying degrees of success. The Texas lawsuit is a problem for many candidates.”

If this Obamacare provision is rescinded, will be “of particular concern for the care of patients suffering from chronic diseases such as autoimmune diseases which require a lifetime of diagnostic and therapy management care,” says James Healy, senior vice president, business development and chief financial officer at DxTerity, a precision medicine company. “Removing this provision greatly reduces the reimbursement of testing and therapy management for this area and the ability of workers with these diseases to change insurance providers for fear of losing coverage.”

3. States will be the primary battleground for healthcare policy, regardless of the outcome of Congressional races during the midterms. “Depending on the outcome of state elections state leaders may spend the next two years trying to expand Medicaid coverage and shore up the health insurance exchanges,” says Ben Isgur, PwC Health Research Institute leader. “While other states may attempt to enact Medicaid work requirements and launch new short-term health plans.”

4. It’s important to ensure that mental health and addiction is covered by insurance. “Historically, this type of coverage has been inadequate, until ACA mandated coverage-which helped many people receive the care they need,” says Olson.

5. It’s important to know the risk of granting money to states without direction. “While state autonomy can be good, it can also be scary when it comes to addiction because most states are not equipped to put the money to its most beneficial use-many times because they have no good options, which is why there has been an overwhelming gap in treatment,” Olson says. Additionally, despite 50 years of evidence as to best practices for treating the chronic disease of addiction (and support from NIH, the Surgeon General, the Secretary of HHS, etc.), many states are still not properly educated or settled on treatment protocols, thus leading to confusion, bias and indecision, according to Olson.

6. Disruption will continue in healthcare reflecting market forces and pressure from the Administration. “Transparency in cost and quality, increased accountability for outcomes and payment tied to these outcomes will enable greater competition and consumer choice. Trends in value-based care will accelerate,” says Numerof.

Promising innovations in healthcare delivery are coming from two places right now: government programs (like Medicare and Medicaid) and and private-sector startups. The government programs have made great strides in promoting value-based care while emerging private sector companies have disrupted the healthcare status-quo with technology and innovation,” according to Gus Crothers, MD, medical director of clinical personnel, at Grand Rounds, a technology company that matches employers and employees to high-quality healthcare.

“The former is funded by taxpayers while the latter is funded by private employers,” says Crothers, a practicing primary care physician in Maine. “The two parties have very different philosophic views on which of these two sources of innovation should be the dominant force in U.S. healthcare. With the balancer of power up for grabs in the midterms, there is a lot at stake for what healthcare innovation will look like in the next few years.

Healthcare executives should understand that everything in the healthcare ecosystem is interconnected, he says. “A policy that allows employers to save money by skimping on healthcare coverage for their employee might save them money up front, but can cost them down the road in lost productivity and increased burden of disease in their community.”

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7. President Trump’s recent signage of the gag clause removal bill and its ability to lower pharmaceutical prices will be touted. “Increased transparency at the pharmacy counter is likely to put greater accountability on drug industry stakeholders, and better information in the hands of consumers,” Numerof says.

8. Providers should prepare for a slightly higher risk of uncompensated care. “Health insurers will have the ability to sell more products, though variations in state regulations will make compliance more challenging,” Isgur says.

9. Election results could lead to limits on Medicare. For the aging population of Americans, coverage from Medicare is the only path to care, according to Healy. “Reductions in coverage and limits placed on this important feature would leave many hospitals, physicians, and labs with unpaid bills and/or the dilemma of turning away those in need. For laboratories, this means depressed margins and slower pay rates for services provided,” he says.

The composition of Congress (and a tacit referendum on healthcare from voters) could lead to legislative actions and potentially more vigorous debate about substantive changes to healthcare financing such as “Medicare for all,” according to Bonis. “The continued unabated rise in healthcare costs and shifting of costs to healthcare consumers will drive Congress to seek near-term wins that directly address affordability. In the meantime, expect costs to continue rising,” he says.

10.  There is more of a focus on out-of-network healthcare costs. “There is a growing dissatisfaction with high bills and poor service,” says Hempstead. “The out-of-network issue is a good example. People want that resolved, and I think the way the issue is framed, providers look more like the bad guys. There is bipartisan support for this issue and some momentum at the federal level. There will be many new governors who might want to take on some health care competition issues, including out-of-network bills. People will increasingly challenge bills that they think are excessive or unfair.”

11.  People are more open to disruptive alternatives. “People are dissatisfied with the delivery system in its current form and are open to disruptive alternatives, including new private sector entities like Amazon or CVS/Aetna, that might deliver care in a more convenient and/or cheaper way,” Hempstead says. “From a policy standpoint, they may support rate-setting, some types of Medicaid buy-ins or public options.”

Regardless of the outcome of the elections, major challenges in healthcare delivery will require more than federal legislative action, according to Bonis. “Changes in the private sector will also be important for understanding the future of healthcare delivery,” he says.