Q: How do you see “re­peal and re­place” play­ing out in Wash­ing­ton?

Modern Healthcare - - NEWS -

Mar­i­lyn Taven­ner, CEO, AHIP

“We all have to ac­knowl­edge that go­ing into 2017, we are not in a great place as a health plan in­dus­try. While I think the Af­ford­able Care Act has done some won­der­ful things—a tremen­dous amount of work went into re­duc­ing (the unin­sured pop­u­la­tion) into the sin­gledigit fig­ure it is to­day and no one wants to lose that—the is­sues to­day are choice and com­pe­ti­tion.

“Lots of plans in the mar­ket were strug­gling with that in the past year. And there were rea­sons that I think we can all point to. … Ex­emp­tions that were too broad so that you ac­tu­ally had as many peo­ple ex­empt­ing out of in­sur­ance as were in; a lack of young peo­ple en­ter­ing the mar­ket be­cause the de­sign was dif­fi­cult to un­der­stand and prob­a­bly not very ap­peal­ing to young peo­ple.

“It’s go­ing to be a very tough road ahead. It is go­ing to be im­pos­si­ble to re­peal and quickly re­place. So how are we go­ing to get through a tran­si­tion pe­riod? That’s prob­a­bly two or three years.”

Don­ald Fisher, CEO, AMGA

“It’s clear that the Trump ad­min­is­tra­tion is go­ing to re­peal Oba­macare in some form or another and they will re­place it. The Repub­li­cans now re­ally get it that there are so many un­in­tended con­se­quences that could oc­cur with a re­peal with­out a re­place im­me­di­ately.

“They don’t want to own it. Be­cause if they break it, they do own it and they’re go­ing to be re­spon­si­ble at the midterm elec­tion and they could lose a lot of seats. So we’re con­vinced that there will be a three-year maybe even a four-year tran­si­tion. There’s just no way to do it that quickly.”

Chip Kahn, CEO, FAH

“There isn’t a clear con­sen­sus among Repub­li­cans. There re­ally isn’t an ad­min­is­tra­tion yet … so they don’t have a pol­icy. And the Repub­li­cans on the Hill didn’t ex­pect to win the elec­tion. … I don’t want to say ‘deer in the head­lights,’ but clearly the dog caught the car.

“It re­ally comes down to one thing in terms of their point of view: the amount of money that was both raised and spent in the ACA for cov­er­age was un­ac­cept­able. If you be­gin with that pre­sump­tion, then (re­peal) presents a real prob­lem to hos­pi­tals and other providers.

“If you take the is­sues that Mar­i­lyn is most con­cerned about, a few bil­lion dol­lars—not a small amount of money—but a few bil­lion dol­lars could ad­dress the ad­verse-se­lec­tion is­sues. But hos­pi­tals will be in real trou­ble. The num­ber they could lose is in the hun­dreds of bil­lions of dol­lars.”

Stephen Ubl, CEO, PhRMA

“In­sur­ers and hos­pi­tals have a lot more at stake. So as we head into choppy wa­ters it’s clearly not in our sec­tor’s best in­ter­est to have the un­cer­tainty that’s been de­scribed by the other pan­elists.

“Our big­gest chal­lenge in health­care is the ris­ing preva­lence of chronic dis­ease. And as we get into health­care 2.0, we shouldn’t lose sight of the fact that chronic dis­ease drives most of our health­care spend­ing. Our com­pa­nies’ prod­ucts stand the best chance of ame­lio­rat­ing those costs.

“As we move to a new sys­tem, the con­tours of which are some­what ap­par­ent—more state flexibility, more ben­e­fit de­sign flexibility, likely more high-de­ductible plans—we are look­ing at cre­atively en­sur­ing that pa­tients con­tinue to have ac­cess to in­no­va­tive treat­ments.”

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