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Democrats Promise Focus on Healthcare

Democrats Promise Focus On Healthcare

Nancy Pelosi’s fate as Speaker of the House is not yet known, but Democrats have already come forward with a healthcare agenda that ties to their campaign promises during the midterm elections.

Democrats promise to reduce and control the costs of prescription drugs, stabilize the Affordable Care Act (ACA), and investigate the actions the administration has taken to undermine the ACA.

We do think that the Democrats could get together with President Trump and Republicans to pass various drug price control measures. These could be both comprehensive in nature and focused on the high cost of drugs in the Medicare program. President Trump is ready and hankering for a victory here.

We do hope the Democrats are able to get some traction on the ACA, but with the loss of some moderate voices in the Senate, it is very much unknown if any responsible plan can make its way through the Congress. It would first mean Democrats reining in their objectives in the House and then the GOP Senate majority coming around to support a bill.

The parties should try to get together to pass something that truly stabilizes the ACA, even in small ways. The benefits of the ACA are well-known.  According to data from the Centers for Disease Control and Prevention (CDC), in early 2018, 28.5 million Americans were uninsured. This is 20.1 million fewer than 2010, before the ACA took effect.

The flaws in the Exchanges would need to be repaired to stabilize offerings in about half of states. This would mean Democrats realizing that aspects of the program are too costly and burdensome, and Republicans admitting that a stable healthcare system is good for Americans and the economy.

During the midterms, Democrats pressed President Trump’s supposed gutting of protections for pre-existing conditions. The truth is he used regulation to allow states to waive requirements if other safety-net funding or programs were put in place. It is possible that the parties could come to an agreement on reversing such measures if the President were to acquiesce, which would, in essence, take a major liability away from the President and his party for the 2020 elections.

But, the results show that the Exchanges alone are not the solution for the uninsured problem.  States that expanded Medicaid experienced the greatest drops in the uninsured rate. The difference can be dramatic between these two types of states – an uninsured rate below 10 percent vs. an uninsured rate approaching 20 percent.  So, states would also need to expand Medicaid as Medicaid expansions get to the poorest of the uninsured. This is a real possibility with Democrats picking up numerous governorships and some legislatures. Already, the elections saw three states endorsing Medicaid expansion (Idaho, Nebraska, and Utah) with one (Montana) defeating it. In other states, Medicaid will remain set near the federal minimum.

Although needed, the likelihood of comprehensive Medicaid reform is a long shot. So, too, are efforts for Democrats to rein in President Trump’s tinkering with both the Exchanges and Medicaid. Expect these regulatory “reforms” to continue.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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