It’s time to step back and assess how the election could impact the managed care industry.
As we head into the final stretch of the 2016 election, it’s important to step back from the fiery rhetoric and hyperbole that defines political campaigns and try to assess the real impact this election could have on the future of the managed healthcare industry. Many of you have already weighed in on these issues in response to Managed Healthcare Executive’s first-ever Politics and Policy Survey, the results of which are featured in this issue.
HallThis is the biggest issue perhaps, and whatever the outcome of the election, the next few years will largely be focused on making programmatic changes to the ACA. Hillary Clinton has proposed increasing incentives for states that haven’t expanded their Medicaid programs, increasing the requirements that insurers have for covering sick visits and managing pharmaceuticals, and creating a government option that would compete in the exchange market. Donald Trump, though vowing to repeal ACA on his first day in office, would most likely work with Congress to make changes to the current program such as allowing health plans to be sold across state lines, increasing the use of HSAs, and allowing individuals to purchase insurance tax free.
Because of the need to reauthorize the Children’s Health Insurance Program, it is likely that many of these changes, regardless of which party wins, will be included in this bill. At the end of the day the Democrats will proclaim ACA 2.0 and the Republicans will claim that the initial ACA has been replaced with their version of healthcare reform.
The program is hitting its stride and is unlikely to be threatened regardless of which party wins. Clinton has indicated an interest in allowing individuals over the age of 55 to buy into Medicare which would significantly expand the market for these programs. She would also like to increase reimbursement for telemedicine to improve access in care in rural areas. Trump's position is not clear as he indicated that he would like to see Medicare privatized with premium supports and he's also he indicated he would like to leave Medicare alone.
The cost pressure on Medicare will see the continuation of the rise in coordinated fee-for-service models (including ACOs and medical homes and an emphasis on value-based payments). Members of Congress on a bipartisan basis will continue to look toward ensuring the long-term viability of Special Needs Plans and state demonstrations that align cost with improved care for sickest, poorest and costliest Medicare/Medicaid beneficiaries.
Don’t expect either party to have any real impact on this. For costs to trend downward, something has to be cut. With an aging, sicker, more entitled population, the push for more services is intense and politicians of both parties are unwilling to risk their jobs by cutting costs. Both Clinton and Trump have indicated that they would like to see the government negotiate with drug manufacturers for better prices but Congress is not likely to support that. Both candidates are pushing for price transparency which is coming anyway because of consumer demand and an increased use of high-deductible health plans options. The real impact on costs will come from consumers, not politicians.
Managed healthcare is here to stay no matter what happens in November, however, the policy changes brought by each candidate will have a great impact on the number of Americans who will be covered and the types of coverage they will have. A President Clinton will very likely increase the number of insured Americans and mandate comprehensive coverage requirements, while a President Trump will likely have the opposite impact. How this ends up will be decided by who shows up in the election booth.
Don Hall, MPH, is principal of DeltaSigma LLC, a consulting practice specializing in strategic problem solving for managed care organizations. He is also a Managed Healthcare Executive editorial advisor.