Politics and Health Policy After the Presidential Election

Working under the assumption that the outcome of the presidential race is pretty set, Avik S. A. Roy, president of the Foundation for Research on Equal Opportunity, and John E. McDonough, DrPH, MPA, of the Harvard T.H. Chan School of Public Health, pondered the potential health policy changes during a Hillary Clinton presidency with a Republican-controlled Congress.

The first day of America’s Health Insurance Plans’ National Conference on Medicare closed out with a discussion on the implication of the 2016 election on public programs.

“Where are we next year in terms of how the parties work?” McDonough asked. “Are they at loggerheads at day 1, as happened in January 2009? Or is there the possibility for real collaboration?”

Bipartisan collaboration on healthcare is possible, despite the deep divide on the Affordable Care Act (ACA). For example, the Medicare Access and CHIP Reauthorization Act was passed by President Barack Obama working with a Republican House and Senate in early 2015.

Roy agreed that making changes to health policy is not impossible. He believes that if Republicans put forth an overhaul of the ACA, that enough Democrats could embrace it.

“The problem is that Republicans are in complete disarray in terms of what they’re for,” he said.

There may be some small, targeted regulatory reforms, but it is unlikely that there will be any larger changes. President Clinton may be willing to make changes on some aspects of the ACA, but, unfortunately, the idea of fixing the ACA has become toxic to many Republicans.

“Will Republicans be willing to go with fixes to the ACA? Or will they worry about being seen as traitors?” Roy asked.

For the most part, the idea is still “repeal,” Roy said, and if something can be spun to include the word, even if it was just changing an unpopular part of the health law, more Republicans might be willing to play ball.

And there is a real possibility that even if there is a smaller Republican majority in the House, that it could be a more conservative and hard line group than Obama faces now, which could mean a tougher group for the White House or the Senate to deal with, McDonough said.

However, there is agreement that changes need to be made to the ACA. Clinton has outlined a “fairly precise” agenda for changes, and even Obama has said things need to be changed, McDonough said.

He identified 3 areas where significant changes should and can be made to the ACA: reinsurance, risk corridors, and risk adjustment. None of these are alien concepts in insurance—in fact they are a part of Medicare Advantage and Medicare Part D and work well.

Roy pointed out that there are ways that the 3 R's were designed in the ACA. The law should have taken into account the uncertainties about what the population that signed up would look like and included more funding for cushioning.

While McDonough agreed the legislation should have accounted for that, he added that Republicans have managed to politicize these boring concepts.

Ultimately, all speculation about the future under a Democratic president came back to the same question: would Republicans agree to changes?

“The challenge is: can Republicans actually tolerate anything that will make [the ACA] work, since they are so committed to obliterating it?” McDonough asked.