Here’s how experts predict healthcare will unfold in 2019.
When Americans voted in the 2018 midterm election, healthcare was a hot issue. Consider the fact that in a PwC Health Research Institute Consumer Survey in September 2018, 59% of the 1,500 respondents cited healthcare as the most important issue. So now that the Democrats will control the House and Republicans will have a greater majority in the Senate, will they attempt to address the healthcare issues Americans are complaining about?
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Congress will start with a clean slate in January. “Many bill sponsors and co-sponsors from the 115th Congress are no longer Congressional members,” says Annette Bechtold, senior vice president of Regulatory Affairs and Reform Initiatives at OneDigital, which provides employers with benefit advisory services. “All old bills that were introduced will be dismissed and all previously proposed legislation will need to be reintroduced. Educating new members while finding new sponsors and co-sponsors will add to the lengthy timeline of getting things accomplished.”
Here’s how experts predict healthcare will unfold in 2019.
1. There could be more changes to the ACA
The Democrats’ midterm wins will likely slow, but not stop, the Republicans’ pursuit of their healthcare agenda-which has focused on deemphasizing the role of the federal government in the U.S. health system, says Benjamin Isgur, health research institute leader, PwC, which analyzes trends affecting health-related industries.
Democratic control of the House likely means that Republican lawmakers will not undertake another attempt for wholesale repeal and replace of the ACA. Rather, the most substantive action related to the ACA will happen as the result of regulation and executive action. Without overwhelming majorities that can grant veto power, however, Democratic lawmakers will have little room to pursue their own agenda without bipartisan support.
But Michael Strazzella, co-head, Washington office and group practice leader of federal government relations at the law firm Buchanan, Ingersoll, & Rooney, PC, believes the Senate, having grown its majority, will make efforts to repeal the ACA as it did in the 115th Congress. “Unlike the last Congress, however, I expect them to ensure that pre-existing conditions are protected in order to ensure that the issue can be avoided during the 2020 elections,” he says. “The House will hold hearings to highlight pieces of the ACA that they consider to be successful. Moreover, they will attempt to further block executive branch efforts to impede implementation of the ACA.”
2. The Trump administration will continue to use regulatory agencies in an attempt to transform Medicaid, roll back industry regulations, and address drug pricing
These changes can be made without congressional input. HHS will move full speed ahead with initiating block grant pilots and enabling states to reduce their Medicaid programs through premium and work requirements, reducing benefits, and raising income thresholds, in order to create savings for poorer states and reduce the federal match to help fund tax reductions, says Gerry Hinkley, JD, leader of the healthcare industry team at Pillsbury Law, which provides legal services that support the healthcare industry. HHS will also continue the “reducing reporting burden” approach carried forward in the 2019 Inpatient Prospective Payment System rule as a basis for accelerating the reduction in Medicare support for inpatient care.
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Regarding drug pricing, the recently-enacted Know the Lowest Price Act and Patient Right to Know Drug Prices Act will improve transparency of drug pricing for patients. “I expect the president to continue to pressure pharmaceutical manufacturers to reduce drug prices, but it’s not clear when or whether further action will be taken by regulatory agencies,” says Eric D. Fader, JD, partner in the law firm Rivkin Radler LLP.
3. The Trump administration will continue to embrace value-based care models, including mandatory ones
The administration is looking for ways to improve the affordability of healthcare and Alex Azar, HHS secretary, has affirmed that this will be the agency’s strategy. Value-based care models are predicated on success and efficiency; they focus on the best care for the best price and reward those outcomes. “More accountability on providers and education of consumers will be the key to bringing healthcare costs in line,” Bechtold says.
Hinkley notes that recent HHS initiatives around home healthcare, for example, demonstrate the administration’s continuing focus on alternate payment models that move away from payment for episodes of care.
4. Certain healthcare initiatives that Republicans and Democrats agree on could gain momentum
Two areas that both parties agree on are prescription drug regulation and stabilizing the individual market, says Arthur Tacchino, JD, chief innovation officer, SyncStream Solutions, a provider of healthcare reporting and compliance solutions. Prescription drugs have been targeted due to their incredibly high prices, and the country’s opioid crisis has drawn attention to them from a health and welfare perspective. “Even prior to the midterm elections there was bipartisan support to help stabilize the individual market, especially because the ACA’s individual mandate was effectively repealed with the GOP tax reform bill in 2017,” he says.
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Mark Luck Olson, chief executive officer, Trainer Rx, an outcomes focused, evidenced-based, and patient-centric tele-rehab platform, says the topic of pre-existing conditions surfaced during the midterm elections, with both political parties considering it important. “They define pre-existing conditions differently, however,” he says. “While Democrats view pre-existing conditions as a necessary right, the Republicans view it as a forced purchase. Ultimately it becomes a question of whether payers think healthcare is a service to be purchased or a right that everyone should have.”
5. Democrats will gain some power
Democrats do not have enough power at the federal level to make any significant changes in the healthcare industry without bipartisan support. However, they will now have enough unilateral power to stop Republican efforts. “Any substantive change through legislation would require both the House and Senate to pass it, and now that Democrats have taken control of the House they have the ability to quash any Republican efforts they do not agree with,” Tacchino says.
Isgur says Democrats will gain more oversight authority, allowing them to hold hearings on the administration’s actions and subpoena agency leaders. These actions may hinder and slow the agency’s work. Democrats likely will question CMS as it considers the additional Section 1115 Medicaid work requirement waiver applications.
Democrats also will have a greater say in the federal budget. “One priority for them will be to include more resources to shore up the ACA individual markets,” Isgur says. “This can take the form of restoring funding for programs that connect beneficiaries to ACA navigators or pushing for restoration of ACA cost-sharing reduction payments to insurers.”
6. States will continue to become an important battleground for healthcare policy
Democratic states that haven’t done so already may seek to mimic the reinsurance programs put into place by states such as Alaska, Maine, Maryland, Minnesota, New Jersey, Oregon, and Wisconsin, which generally pay high-cost ACA claims in order to lower ACA premiums, Isgur says.
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Democratic-led states may also seek to recreate ACA protections that have been unwound at the federal level. States such as New Jersey, Vermont, and Massachusetts have enacted individual mandate penalties to stand in for the federal one. These states are also more likely to adopt legislation calling for greater transparency in drug price increases.
Furthermore, Democratic gubernatorial wins in the states that have not expanded Medicaid under the ACA could lead to further expansions. “Democratic wins on the state level could also slow the spread of work requirement programs for some Medicaid beneficiaries in states formerly led by Republican governors,” Isgur says. In addition to changes in statehouses, several attorney general offices flipped from Republican to Democrat. “Legal challenges to health policy have abounded in recent years, often led by attorneys general, so changes in party could shift the direction of these courtroom showdowns.”
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.