Industry experts describe what may be in store during an eventful year, and how leaders should be approaching the potential turmoil.
As 2017 ushers in a drastically different political environment, it also brings uncertainty on a variety of issues.
Not least of those issues is the fate of the Affordable Care Act (ACA). Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy, Durham, N.C., believes Republicans will work quickly to repeal the ACA now that they have assumed control of the White House through the election of Donald Trump while maintaining a majority in Congress. But exactly what would replace the ACA is unclear.
“There is still a lot of work to be done to develop the policies and the politics that would make a replacement alternative work well, so we are going to be living for a while with some uncertainty about what exactly an ACA replacement would look like,” he says.
Other issues concern the timing and logistics of a repeal. One tactic might involve an immediate vote to repeal that would take effect in a few years, with efforts to develop a replacement plan in the meantime. Another tactic might delay the repeal decision as Republicans unify around a replacement strategy. Whichever timeline Republicans choose, McClellan anticipates their efforts will significantly alter several components of the ACA.
The leading Republican alternatives to replace the coverage components of the ACA include a fixed tax credit to help individuals purchase insurance, with additional assistance available through states for lower-income and higher-risk patients. In lieu of an individual mandate to purchase insurance, Republicans could propose a continuous-coverage requirement, similar to current portability requirements under HIPAA, that would allow individuals to avoid underwriting and have access to coverage at the median level or population rate, McClellan says.
McClellan believes language in the repeal itself could provide some hints as to what coverage under the ACA replacement would look like. For example, Republicans may decide to preserve some sources of ACA financing to fund tax credits in a new law. More will likely become clear in early 2017.
Based on policymakers’ discussions, Francois de Brantes, MS, MBA, vice president and director of the Center for Payment Innovation at the Altarum Institute, Ann Arbor, Mich., speculates that the replacement plan could create a national set of exchanges to encourage cross-border competition among health plans. That could create new dynamics among insurance carriers, including those that have enjoyed market dominance because of a lack of regional competition, he says.
“If there truly were more competition across borders through the exchanges, it would create a far greater dynamic in getting the plans to take payment reform more seriously,” he says. “They would lose a tremendous amount of business in the exchanges if they didn’t figure out how to be more innovative and how to reduce premium costs or at least reduce the rate of increase in premium costs so they could beat out their competitors.”
Laura Ramos Hegwer is a freelance writer and editor based in Lake Bluff, Ill. ([email protected]).
Interviewed for this article:
Mark McClellan, MD, PhD, director, Margolis Center for Health Policy, Duke University, Durham, N.C.; Francois de Brantes, MS, MBA, vice president and director, Center for Payment Innovation, Altarum Institute, Ann Arbor, Mich..
