Rita Numerof on ACA repeal: A second chance to get health reform right

Document titled "Patient Protection and Affordable Care Act"
In an exclusive interview with FierceHealthcare, Rita Numerof, president of healthcare management consulting firm Numerof & Associates, says the push to repeal the Affordable Care Act will lead to more innovation and market-based solutions. (Photo credit: Getty/designer491)

While some industry experts fear that President Donald Trump’s executive order to push for a quick repeal of the Affordable Care Act will create even more instability in the individual marketplaces, one global healthcare strategist is optimistic that it will lead to more innovation and market-based solutions.

Rita Numerof
Rita Numerof

Rita Numerof, president of healthcare management consulting firm Numerof & Associates, who describes herself as a longtime proponent for healthcare reform, isn’t convinced that the fear, angst and worst-case scenarios bandied about in the last few days are based on facts. 

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She suggests Americans take a deep breath and see what unfolds. “We didn’t get here overnight,” Numerof told FierceHealthcare in an exclusive interview, “and it won’t be gone overnight. No one has said you are going to lose coverage. The fear-mongering is not helpful.”

ACA: "Doomed from the start"

Although President Barack Obama’s signature legislation did achieve its goal of reducing the number of Americans without health insurance, she says it also added narrow, prescriptive regulations that shifted the focus from care delivery to compliance with rules.

That approach meant the ACA was “doomed” from the very start, Numerof says.

Trump’s executive order, she says, is consistent with what he suggested during forums leading up to and after the election. It also aligns with several Republican proposals for repeal. What’s ironic, she notes, is that the same provision that allowed the secretary of the U.S. Department of Health and Human Services to craft the rules and laws of the ACA is the same one Trump and the future HHS secretary will use to unwind the law and replace it with something fundamentally different.

“With a stroke of a pen, there is a new order giving greater power to local areas, states in particular, to put in motion real opportunity for innovation and market-based solutions,” she says.

New mandate will spur innovation

Despite the unknowns ahead, she thinks the fears over the ACA replacement plan are unjustified. She notes that Trump, Rep. Tom Price, his pick to serve as head of the HHS, and House Speaker Paul Ryan have all said that they don’t intend to roll back healthcare and insurance to what it was like prior to the ACA. Her take: “I think there is general agreement that healthcare reform is needed, just not the version that unfolded under the last administration.”

Instead of the individual mandate to buy a “particular kind of insurance with particular provisions at a narrow price range,” she believes Trump’s action will set in motion an opportunity for real consumer choice. The limits of the insurance coverage within the current exchanges don’t mesh with society’s view that “people should not be forced to buy things they don’t want and don’t need.”

Numerof believes that the mandate will spur insurance companies to design products at price points that meet the needs of different consumers and their families. Small businesses, she says, may also be able to work together to buy products designed for them and sold across state lines.

And, she notes, some of the most popular provisions of the ACA are not under threat. For example, Trump’s mandate says nothing about removing the provision that requires insurers to cover preexisting conditions. “There is much agreement that this was a good change. But did we need 2,700 pages and a bunch of other rules to get to that point?”

This new round of reform will help fix serious problems that plague the healthcare industry, such as lack of price transparency and accountability, according to Numerof. It’s a second chance to get healthcare reform right, she says.