Transcript What Changes Can We Expect From Our Government in

2017 Health Care
Policy Preview
Elections determine the starting
point for policy conversations.
Divided Government
A Whole New World
For 2017, there are three major health
care policy areas.
The Affordable Care Act (ACA)
Medicare, Medicaid, and CHIP
Prescription Drug Pricing
The Affordable Care Act
The ACA is not working as
well as expected.
The ACA is not working as well as expected.
That is a fact.
In 2013, 24 million Americans were predicted
to have joined the exchanges by now. There
are half of that in the exchanges now.
Competition is shrinking. Last year only 7%
of counties had only one insurer. Next year,
it is projected to be 31%.
The ACA has two problems.
One is about participants.
The other is about costs.
The first problem is that the pool is sicker
than expected which is a function of lower
than expected participation rates by younger,
healthier people.
The second problem the ACA faces
is that health care is expensive for
the consumer.
The share of health care cost paid for by
the government versus the share of
health care costs paid for by the
beneficiary is a policy choice.
The ACA is about to undergo a
metamorphosis.
‘Repeal and Replace’ is really
better described as transition
Republicans and ACA Transition
•The Role of Insurers
•Disruption
•Hard Choices
Medicare, Medicaid and CHIP
In 2015, Congress finally replaced the
fundamentally flawed SGR payment policy in the
Medicare and CHIP Reauthorization Act, now
commonly referred to as MACRA.
MACRA is a fundamental shift in Medicare policy.
It’s not simply that it ended the flawed SGR, but it
is that it moved the Medicare program away from
fee-for-service.
MACRA creates significant, unified data reporting
requirements for providers.
There will be financial winners and losers based on
the data reporting.
The House of Medicine hated the
SGR. That doesn’t mean they are
in love with the replacement.
Pick Your Pace = MACRA Delay
Everyone Gets a Trophy
MACRA was bipartisan,
bicameral passing
overwhelmingly.
In 2017, Congress must consider
therapy caps and CHIP and a handful of
other extenders.
Legislators gonna
legislate.
Entitlement Reform
Republicans would like to move Medicare to
a premium support model.
Republicans would like to move Medicaid to
a block grant or a per capita cap model.
ACA replacement and entitlement reform is
one …
VERY BIG BITE
Prescription Drug Pricing
Drug pricing is a hot political issue
being talked about on both sides of the aisle
You can’t spend all of 2016
talking drug pricing and claim
amnesia on Nov 9th.
The user fee acts will be on the table in 2017.
Monsters Abound in Health Care Policy
Downward cost pressure on all
health care stakeholders remains
in effect for 2017
Let’s talk about you
Happiness is talking health care policy.
Rodney L. Whitlock
[email protected]