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Midterm Results Likely Mean Gridlock but Certain Healthcare Issues Could Get Traction

Midterm Results Likely Mean Gridlock But Certain Healthcare Issues Could Get Traction

President Donald Trump surprised everyone by galvanizing the Republican base in a number of states to stop what was once thought to be a Blue Wave on Election Day. The Democrats did retake the House, but the President’s campaign rounds seem to have decided a number of Senate races in Republicans’ favor. The Senate increased its majority. As important for Trump, that new Senate majority looks to be far more Trumpian than before as a number of conservatives succeeded more moderate GOP members.

While we would hope that divided government could mean good governance and policy, the likelihood is more gridlock. On some healthcare issues, that could very well be good news. On others, not so much. There is the possibility that Democrats and Republicans could come together on a few issues plaguing the healthcare system.

So what might happen?

Obamacare: With the House in Democratic hands, efforts to repeal and replace the Affordable Care Act (ACA) is likely now dead. At the same time, we know that the Exchange program is on life support in about half of all states. Too few plans and providers are willing to be part of Obamacare and insurance rates keep going up. As readers of this blog, we have always been in favor of maintaining the program but enacting common-sense reforms.

Medicaid: A similar outcome as with Obamacare is likely. Efforts to expand the program nationally to serve more uninsured would be stopped by a more conservative Senate. At the same time, conservative efforts to convert the program into a per capita cap or block program will go nowhere as well. The Trump administration will likely use their administrative waiver authority to pursue some of the reforms it had hoped to pass legislatively. Interestingly, there were four state ballot initiatives on Medicaid expansion that produced mixed results. Expansion prevailed in Nebraska, Idaho and Utah, but failed in Montana. With more Democratic Governors and state legislatures, it is possible that more states could legislate an expansion at the state level.

Medicare: The ACA meant cuts to Medicare in order to pass Obamacare. Most of this hit providers, including Medicare Advantage plans. With a divided government, it is unlikely you will see sincere efforts to reform Medicare to ensure it has long-term stability. Democrats won’t touch it. GOP proposals will be too radical. On the Medicare Advantage (MA) front, though, both parties are strong advocates of MA. Congress will continue to back the program and its growth trajectory will remain. The strong quality and compliance regime will continue.

Drug Pricing: Drug pricing is one area where the parties could come together to enact bipartisan reform. The prospect is buoyed by the President’s recent endorsement of price controls by pegging certain drugs in Medicare to international pricing. Democrats are known to like this type of policy, along with reimportation, transparency, Medicare cost-sharing changes, and drug introduction reform. Trump, too, has indicated support for most of those ideas.

The Opioid crisis: Here, too, the parties could come together on a national plan to address this crisis.

With a divided government and no consensus on healthcare in general, the “have vs. have not” patchwork will continue, with gaps growing. Relatively wealthy, urban and progressive states will continue to expand programs. Others, mostly in the South, will not and likely will see additional issues with the stability of Obamacare.

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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