The ACA and the Election: Sorting Things Out

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article. 

Tuesday’s election results confirmed that the country isn’t happy about its direction, perplexed about national security, divided about health reform and the Affordable Care Act and frustrated about its political system. More stayed home than voted. Pundits called it a “wave” election.

It turns out healthcare was a key issue, second only to national security per the exit polls. Since passage of the Affordable Care Act (March 2010), our industry has been front and center in public debate. And as a result, our successes and shortcomings are hot topics in every boardroom, family gathering and legislative chamber at the local, state and federal levels. Some in our ranks would prefer it be left alone reasoning we’ve done well sans public transparency and political intrusion thank you very much. But it’s naïve to imagine that our future isn’t fundamentally different that our recent past, wave or no wave, ACA or not. Here’s why:

Regardless of how Congress navigates through its forthcoming budget deliberation, the Supreme Court settles the question of subsidies or the insurance marketplace fares when Open Enrollment starts again this Saturday, increasing health costs and the value derived from these expenditures will be our industry’s foremost challenge.

I don’t know how to fix a car or wire a circuit board, but I know when my car is running and my device is working. The same is true of the U.S. health system: the majority believe it’s not working including those with health insurance, those in positions of industry leadership and the 14 million in its employed workforce. Our value proposition-what we deliver for $9,000 per capita—is unclear.

To employers, it’s a vital industry to recruiting and keeping employees, but a disadvantage in a global competition and constraint on profits.

To elected officials, it’s a complicated array of laws, rules and regulations that often seem at odds with common sense or inconsistent between agencies and programs.

To families, it’s a lifeline for our seniors and vital to happiness and stability, but increasingly at odds with financial security: the majority think they’re at risk for being wiped out by medical debt and costs for healthcare are increasing significantly faster than wages.

The CMS Office of the Actuary predicts health spending will increase 5.7% annually for the next decade, while our economy will scramble to crawl back to 3.5-4% annual GDP growth. Historically, the health industry has done well financially when the rest of the economy struggled, and we do better when the rest are doing well. The profitability in many of our sectors has improved since passage of the ACA, even as our fierce intramural conflicts—hospitals vs. health insurers, primary care vs. specialists, alternative health vs. traditional medicine, et al-- have become more strident.

Is our industry’s value proposition bulletproof to withstand closer scrutiny? Can our case be made clearly and supported objectively beyond our own profits? That’s the issue we face. The election didn’t change that.

Paul

P.S. Open Enrollment starts Saturday. In “Government Pulse,” see a recap of results from last year’s enrollment and estimate for results this year. Also, for a recap of last Tuesday’s 27 health related ballot initiatives results, see 2014 Mid-Term Election Health Care Referenda,” Navigant Center for Healthcare Research and Policy Analysis, November 10, 2014.

Sources: “Table 1: National Health Expenditures and Selected Economic Indicators, Levels and Annual Percentage Change: Calendar Years 2004-2019,” Centers for Medicare and Medicaid Services, September 2010; “National Health Expenditure Data,” Center for Medicare & Medicaid Services, The Office of the Actuary, accessed November 9, 2014; “National Income and Product Accounts Gross Domestic Product, Third Quarter 2014 (Advance Estimate),” U. S. Department of Commerce, Bureau of Economic Analysis, October 30, 2014

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

© 2014 Navigant Consulting, Inc.