Healthcare 2.0: The Path Forward on Health Reform

Protecting coverage gains that were made under the Affordable Care Act was one of the top concerns of experts representing insurers, physicians, and hospitals during a panel discussion at America’s Health Insurance Plans (AHIP)’s National Health Policy Conference, held March 8-9 in Washington, DC.

Moderator Michael Ramlet, the co-founder and CEO of Morning Consult, referred to the Affordable Care Act (ACA) as healthcare reform 1.0, which was very focused on increasing access to care and coverage. However, the landscape has changed: today the focus is on cost.

“Healthcare 2.0 will be treacherous,” he said. Even among Republicans there is not consensus on how to move forward. Morning Consult has found that while 46% of Americans want the ACA repealed, 43% want to see it fixed, and 11% want it expanded. “We will see this challenging landscape where there isn’t really a clear path.”

Marilyn Tavenner, president and CEO of AHIP, said that her organization believes it is very important to keep as many members covered as possible, not only in Medicaid and the individual markets, but also in the employer market.

The GOP plan to replace the ACA would get rid of the subsidies and replace them with refundable tax credits, which might not be enough to keep the coverage level, she added. In addition, the 30% premium penalty that people would have to pay if they do not maintain continuous coverage could be just as onerous as the individual mandate that the Republican plan repeals, Tavenner said.

Charles N. Kahn, president of the American Federation of Hospitals, said he wasn’t surprised to hear President Donald Trump say that healthcare is hard. In fact, he thinks former Presidents Bill Clinton and Barack Obama probably came to similar, jarring revelations when they began work on reforming healthcare.

As Republicans work on the American Health Care Act, Kahn’s organization has a set of principles that it believes need to be met, including supporting low-income Americans who don’t have the resources to afford coverage and protecting coverage for those who have it now.

“We have seen historic gains, we are at a historic low of the uninsured rate in our country,” said Darilyn V. Moyer, MD, FACP, executive vice president and CEO of the American College of Physicians. “And we need to make sure that we continue to see those gains and allow ready access [and] essential benefits.”

Moyer and Andrew W. Gurman, MD, president of the American Medical Association, both focused their opening comments on reducing burdens for their members, the physicians. Improving physician satisfaction was one of the key strategies for both organizations.

“It’s clear that physicians who are satisfied with their work provide better quality care,” Gurman said.

He also took some time to comment on the president’s immigration policies, which affects a large number of patients in the country. Nearly 300,000 practicing physicians graduated from a foreign medical school, and there are thousands of graduating medical students from foreign medical schools who are waiting to be matched for a residency position. In rural areas, the international medical graduate could be the only person residents of the area can depend on.

The conversation then turned to costs. Gurman is still a practicing physician who often sees patients with high deductibles and out-of-pocket costs that essentially prevent them from getting treatment they need. However, Kahn, who has worked in the industry since the late 1970s, pointed out that the trend of high cost sharing began before Obama.

“The dilemma here is that the only cost containment … that works is cost sharing, but at the same time cost sharing can become such a burden that it takes care away,” Kahn said.

Drug prices were also discussed. While everyone can appreciate new technology, innovation, and cures—all of which can contribute to rising drug prices—huge price hikes on drugs that have been on the market for years, even decades, are something no one appreciates, Tavenner said.

Gurman highlighted a new drug coming to the US market that has been used overseas to treat Duchenne muscular dystrophy for years. While the drug is being priced at $89,000 a year in the United States, it is less than $2000 elsewhere in the world.

“This is madness. This is reprehensible. And this has to stop,” Gurman said. “My fear is that if it doesn’t stop voluntarily … the government is going to come in to fix it, and I don’t think any of us want that.”