Cleveland Clinic's Toby Cosgrove, former HHS head Kathleen Sebelius talk future of healthcare, ACA

Signs saying healthcare reform
Cleveland Clinic CEO Toby Cosgrove said legislators can support providers by taking on drug prices and promoting population health initiatives as the debate continues to swirl around the future of the Affordable Care Act. Image: Getty/Eugenia Chaikina

WASHINGTON, D.C.—Cleveland Clinic CEO Toby Cosgrove, M.D., said during the Republican National Convention last July that he didn’t think the Affordable Care Act would be fully dismantled by the GOP should they win the presidential election.

On Wednesday morning, in the wake of the Republicans’ failed attempt to repeal the much-maligned law and replace it with their own American Health Care Act, Cosgrove was asked if his opinion on the issue had changed. His answer was simple: “No.”

“I think it’s hard to begin to take away coverage,” Cosgrove said. “I think it’s politically very difficult to swallow.”

Cosgrove was one of three stakeholders invited to a discussion on the future of healthcare, which was hosted by Chuck Todd of NBC News and Axios CEO Jim VandeHei. Former Department of Health and Human Services Secretary Kathleen Sebelius and House Majority Leader Rep. Kevin McCarthy, (R-Ca.) also participated.

What’s next for the ACA?

McCarthy said that the AHCA’s failure to pass was not a loss for the GOP. In politics, there are ups and downs, but he said he is “highly confident” that a repeal of the ACA will be passed this year.

As for what their updated plan might look like, McCarthy touched on a number of the Republicans’ healthcare talking points: High-risk pools and increased competition in the individual insurance markets. He said ongoing talks among Republicans include a potential federal list that would unite the chronically ill in a nationwide high-risk pool.

“Let’s take a step back and make it more simple,” he said.

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He compared the party's vision of insurance options to buying a cable package: When someone decides to hook up cable, he or she can choose to include a bunch of add-ons, or move forward with something basic. This is something healthcare consumers aren’t offered today under the ACA, he argued, because of the provisions that mandate certain types of coverage under its essential health benefits. More options and the ability to customize plans allows for lower premiums and lower healthcare costs, he said.

“You can’t do that in healthcare today,” he said. “You take away the ability for the healthcare insurers to offer options.”

Sebelius agreed that the ACA exchanges need more competition.

“We certainly need to get more insurers to play in the exchanges,” she said. But, she added, some of the steps the Republicans want to take could return the individual markets to the the pre-ACA days, where people were segmented by the diseases they had and were often priced out of getting insurance.

Offering customizable plans, even if protections for people with pre-existing conditions are codified in a new law, could also pave the way for insurers to back-door those people instead.

Sebelius was Kansas Insurance Commissioner for nearly a decade, and she said she saw the worst of what can happen in the individual markets in that role. “It was the Wild West,” she said.

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Also of concern, she said, is that the confusion surrounding what exactly the GOP will accomplish on healthcare, if anything, could sink the ACA’s exchanges anyway, even if Congress fails to repeal the law. Without a more concrete direction established in the next two months, the number of payers planning to participate in 2018 could dwindle further.

Major insurers, including Aetna and Humana, have scaled back or fully left the exchanges already. Anthem is mulling a similar exit.

“They could unravel this plan next year because insurers need some certainty,” she said.

How legislators can support providers

McCarthy focused mostly on concerns about rising premiums and lack of competition in the ACA exchanges, but Sebelius and Cosgrove both noted that the ACA is also driving efforts to reduce healthcare costs and transition the industry away from the traditional fee-for-service model. Sebelius said these provisions in the law are its “untold story.”

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Cosgrove said that countries across the world are facing the same concerns related to healthcare costs, especially an aging population that has more options for chronic disease care. Even if the ACA is repealed, there are still things that can be done to improve the outlook for providers, he said.

Population health efforts must continue, for one. For instance, he said obesity drives 10% of U.S. healthcare costs, and there are wellness initiatives and programs that can be put in place to reduce the costs related to that issue and others like it, like smoking.

“You’re never going to control the costs of healthcare until we control the things that are driving increased costs,” he said.

RELATED: ACA repeal threatens hospital innovations that improve patient care

Legislators also have a significant power to control skyrocketing drug prices, he said, an issue of particular import to both providers and patients. Another area for politicians to consider is to have federal agencies ease off a bit on preventing hospitals and health networks from consolidating. Individual hospitals, particularly smaller rural or community facilities, often cannot provide everything that a large patient population might need on their own, he said.

“We have to realize that not all hospitals can be all things for all people,” Cosgrove said.

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