We all have our expectations of how the new year will shape up, and we usually have our illusions smashed pretty quickly. Here are my hopes--and actual expectations--for the healthcare sector in 2016:
I hope at least 10 more states expand Medicaid under the Affordable Care Act. That would be a boon to hospitals, particular rural facilities in the Southern states. But I don't actually expect any Southern states to expand Medicaid at all.
I hope the Affordable Care Act (ACA) remains intact. The sixth anniversary of the passage of the ACA is just two months away. Yet the healthcare reform law remains in perilous waters. Expect it to be a major talking point during the GOP presidential campaign, and expect to see something pretty drastic occur if a Republican wins the White House. My own expectation is that the ACA remains mostly intact, but the medical device and the "Cadillac" employer group tax--which President Barack Obama agreed recently to put off for two years--are likely gone forever.
I hope to see Massachusetts get its act together on price transparency. The Bay State made history by requiring payers to provide timely pricing for healthcare services to any consumer who asks. But it's been clear that many providers are unprepared to provide this information, and many consumers are not aware they can obtain such data anyway. My expectation is that there will be little change here, and as a consequence, a badly needed push for price transparency in this country will stumble.
I hope to see the feds meddle in more mergers and acquisitions. The Federal Trade Commission and the Justice Department were certainly a pain to providers in Chicago, West Virginia, Pennsylvania and Idaho in the waning weeks of 2015, either suing to block pending deals or finally obtaining court orders to unwind them. There are already enough obstacles in this country to providing affordable healthcare. Less competition among providers is not going to help. My expectation is to see an uptick in regulatory interventions, but nothing too dramatic. If the GOP captures the White House, expect that momentum to evaporate.
I hope to see fewer hospital schemes to strongarm patients. As I reported last year, Texas Health Resource's habit of taping recording phone calls with patients in order to improve upfront collections was truly disturbing, particularly the lack of introspection among its executives when I asked about it at last year's Healthcare Financial Management Association conference. My expectation is that we will continue to see patients being dunned by not-for-profit hospitals in a way that belies their community missions. – Ron (@FierceHealth)