In the movie "The Dark Knight," there’s a great scene in which Morgan Freeman’s character, Lucius Fox, savagely foils an accountant’s plan to blackmail Bruce Wayne upon discovering that he is, in fact, Batman.
Says Fox to the accountant: “Let me get this straight. You think that your client, one of the wealthiest, most powerful men in the world, is secretly a vigilante who spends his nights beating criminals to a pulp with his bare hands, and your plan is to blackmail this person?”
[pause for dramatic effect]
Now that everyone had had enough time to digest the results of the Nov. 8 election, I can almost hear Affordable Care Act supporters turning to Republicans with the same sarcastic phrase.
Democratic lawmakers, especially, are eager to play the “I told you so” game once the GOP inevitably struggles to deliver on the promise of repealing and replacing the ACA. That’s not necessarily a knock on the party that's soon to be in power; the task is just going to be incredibly complicated and fraught with political landmines.
In fact, the people who should know best—those in the healthcare industry—are pretty clearly concerned about whether Congress and the new administration can pull it off. Just look at what’s transpired in the last week or so:
- America’s Health Insurance Plans offered a detailed outline of policy recommendations that it hopes will keep the individual markets, Medicaid and Medicare Advantage from seeing too much disruption amid the looming transition.
- An analysis commissioned by two powerful hospital lobbying groups warned that an ACA repeal that reinstates rollbacks on Medicare and Medicaid payments would cost the industry billions of dollars, hurt access to care and weaken local economies.
Hospitals warn Trump, Congress of massive losses with Affordable Care Act repeal https://t.co/27CFXoviP2— FAH (@FedAmerHospital) December 7, 2016
- The Health Practice Council of the American Academy of Actuaries sent a letter to Congress warning of “potentially severe consequences” for the individual health insurance market if the Affordable Care Act is repealed without a simultaneous replacement, or if reimbursements to insurers for cost-sharing reduction subsidies are eliminated.
- The Health Care Transformation Task Force sent a letter asking in no uncertain terms that the Trump administration and Congress indicate its support of the transition to value-based care. “This is not the time for policymakers to waver or reverse course, which would send a negative message to the industry and chill ongoing transformation efforts,” said the task force comprised of payers, providers and purchasers.
We’re calling on the Trump-Pence administration to continue the transformation to a value-based health care system https://t.co/VH76pNH08M— HCTTF (@HCTTF) December 7, 2016
- Agnes Soucat, the World Health Organization’s director of health system governance and financing, said at a news briefing Friday that her group encourages the new U.S. administration to “make sure that the social contract is expanded and that all U.S. citizens have access to healthcare,” according to Reuters.
- A group of nurses, doctors and other healthcare professionals described in a telebriefing last week how they met with Congress members to urge them to lay out their plan for continuing to protect patients’ coverage before executing an ACA repeal. “Our patients are scared,” said one clinic worker.
Republicans’ answer to such concerns, so far, has been to float the prospect of repealing the ACA right away but delaying implementation until they can establish a satisfactory replacement. But “repeal and delay” isn’t exactly a panacea, as it relies on the flawed assumption that the ACA marketplaces are going to hum along in the interim despite their imminent demise.
Not only are some health insurers already jumping ship, but as the actuaries’ letter alludes to, cost-sharing reductions could indeed disappear now that the fate of the House v. Burwell case will be up to Trump. “If insurance companies believe cost-sharing subsidies will not continue, they are going to pull out of the market during the next logical opportunity,” AHIP President and CEO Marilyn Tavenner said.
And if the individual markets collapse, the coverage disruptions that could have dire political repercussions for Republicans will indeed come to pass.
So what’s the GOP to do? Well it’s a good start that Trump’s pick for Department of Health and Human Services secretary, Tom Price, is a doctor. But it won’t count for much if he and other policymakers don’t maintain open lines of communication with a healthcare industry that stands to lose or gain a great deal with whatever policies they implement.
Good ideas are already out there: Keep up the momentum toward value-based care. Find a suitable replacement for the individual mandate. Allow states, enrollees and health plans time to adjust to any new Medicaid financing system.
All policymakers have to do is listen, then work toward creating sustainable solutions that at least try to satisfy both sides of the aisle. A rush to repeal quickly, without taking steps to prevent potential damage, will satisfy the GOP’s base but alienate scores more. If Republicans choose that path, out of arrogance or just plain impatience, well … good luck.