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