Congress and New President Must Approach ACA Repeal and Replace Carefully; Moving Too Quickly Could Be a Disaster
November 28, 2016
A few months ago, I wrote an opinion piece “Old System, Old Rules Don’t Apply to New Health Care System.” Against a pre-election backdrop, I acknowledged the leading candidates’ divergent health care policy views.
I also suggested that regardless of who won, we were likely to be a long way from the implementation of any significant policy shifts. I called upon stakeholders to plow ahead to transform health care, rather than wait for appointments and policy development to unfold.
My sense of timing was, well, wrong.
The morning of November 9, the president-elect, Donald Trump, said repeal and replace of the Affordable Care Act (ACA) will be a top priority. Many Republican leaders in the House and Senate are in agreement, but the “how” is very much up in the air.
We can look to House Speaker Paul Ryan’s white paper, A Better Way, as a possible guide, but there are more questions than answers right now.
Nonetheless, it appears that fast-tracking repeal and replace, and the early movement of proposals even before inauguration of the president-elect, is a real possibility.
Mind you, the ACA is not perfect, and we should always consider refinements and improvements. However, I oppose a complete repeal, and I have many concerns about a repeal and replace that is done too quickly or one that is incomplete.
- Concern one is for 20 million plus people in this country currently covered through the marketplace, Medicaid expansion, and parent plans; and millions more who are benefiting from the protections provided under the law—things like coverage for patients with pre-existing conditions, preventative services, no life-time limits. The ACA has realized the promise and security of comprehensive coverage for so many.
- Concern two is for those who are contemplating coverage. They face enormous uncertainty as they decide whether to sign up for insurance and whether those plans will remain valid.
- Concern three is for the provider community that is continuing to adapt to the move from volume- to value-based payment, making significant financial adjustments and investments, and changing strategic plans. An ACA repeal that lacks a meaningful policy alternative will further strain hospitals and physicians, and create instability for the major transformation underway.
The ACA is complex. The insurance coverage provisions are intertwined with quality incentives, new payment and delivery system models, and innovative pilot programs. There is a critical element of experimentation built into the ACA that should not be lost.
To protect the health and economic stability of Pennsylvania, any ACA adjustments or replacements must:
- Safeguard coverage gains
- Promote the financial stability of hospitals
- Continue the transformation of health care
At the end of the day, it doesn’t matter what the election data tells us about how people voted on the Pennsylvania map. When it comes to health, vulnerable rural and urban communities have all too much in common. Both struggle with high rates of chronic disease, lack of access to primary care, limited economic resources, and higher numbers of uninsured and under-insured people.
As we strive to influence this fast-moving policy debate, we must prevail over entrenched differences that sometimes seem insurmountable. HAP will continue to advocate for federal policy coverage provisions that:
- Reduce the number of uninsured
- Ensure continuity of coverage through access to a robust, competitive delivery system
- Protect coverage for pre-existing conditions, the option for minors to remain on their parents’ plan, and access to preventive services
We will take advantage of our strong relationships with the members of the Pennsylvania Congressional Delegation to help them consider the impact of proposed policies, and understand the consequences for their constituents and the patients we serve.
Undoing the ACA, whatever that means, will require a heavy lift, and the ramifications of each decision must be carefully considered.