Becker's Hospital Review

31 Executive Briefing The Presidential Election and Its Impact on the Future of Healthcare Reform D onald Trump became the president-elect on Nov. 9, 2016. During the presidential campaign his healthcare plan evolved to include: repeal and replacement of the ACA, transitioning Medicaid into a block grant system which would give states more control over the program's funding and eligi- bility, and promoting competition among insurance companies by allowing them to sell policies across state lines as a means of lowering or holding health insurance rates. President-elect Trump's policies favor a free market approach to healthcare, but he has also spoken against "letting people die in the streets" due to lack of medical insurance. With a Republi- can Congress backing him up, an ACA repeal seems likely and it could be replaced with any number of plans, including Speaker of the House Paul Ryan's long-touted healthcare bill. At an executive roundtable sponsored by North American Part- ners in Anesthesia at the Becker's Hospital Review 5th Annual CEO + CFO Roundtable in Chicago, several hospital and health- care executives gathered to discuss the results of this year's election, how those results might impact their organizations, and what steps they will take to prepare for those changes. While there was general agreement at the session that change is im- minent for the healthcare system, most said that their hospitals' missions, visions, services and priorities will remain the same. The conversation, moderated by NAPA EVP of Business Devel- opment Peter H. Doerner, led to a lively discussion of opinions and ideas. "It doesn't really matter which person won [the election]," said Mark Herzog, President and CEO of Holy Family Memorial in Manitowoc, Wis. "We try to create an infrastructure in healthcare that is adaptable. Four years from now, someone else may be in office and there could be another big change, so getting too reliant on which direction the wind blows politically is something we try to take out of the equation." The specifics about if and how President Trump will dismantle the ACA and rebuild are uncertain and the impact of any new legislation is unknown. However, the participants in the execu- tive roundtable discussed seven areas of major concern today that will continue to challenge healthcare providers in the future: 1. Access to care for the uninsured and under-insured. Many states took advantage of the ACA's Medicaid expansion, accept- ing federal dollars to cover more citizens under Medicaid. The increased coverage gave millions of Americans access to health- care services. However, The Commonwealth Fund projects that Mr. Trump's Medicaid block grants for the states could leave 25 million Americans uninsured. Long-time national healthcare strategy and marketing consul- tant Rhoda Weiss, president of Santa Monica, Calif.-based Rhoda Weiss Consulting Group, highlighted the millions of Americans who rely on ACA and expanded Medicaid. "While there are lots of unknowns," she said, "pullbacks could disrupt access to care, minimize progress made in improving health for this population and negatively impact the bottom line of hospitals, physicians and related healthcare organizations — especially those who care for the newly insured and have little to no margins." She spoke to several colleagues after the election who expressed concern about the impact of Mr. Trump's plan on the under- and uninsured populations, potential consequences of block grants in terms of inadequate funding, changes in Medicare and the fear it would bring aging and disabled populations and overall challenges of organizations to plan and strategize in an era of uncertainty. There were multiple hospital executives in Medicaid expansion states who reported their charity care dropped dramatically after the expansion but would likely return to at least previous levels if Mr. Trump implements block grants for Medicaid. There was also concern about access to health insurance if the ACA is repealed. "Throwing out healthcare reform means throw - ing out the insurance reform too," said Mr. Herzog. "From the bigger societal point of view, this means all of a sudden pre-ex- isting conditions will be a factor and people are going to be a slave to their jobs to make sure they're covered." Patrice Weiss, MD, CMO of Roanoke, Va.-based Carilion Clinic, Virginia Tech Carilion School of Medicine pointed out the federal government's responsibility in driving access to care issues; un- less the government approves more residency slots, there will be a lack of trained physicians in the United States. "Not increasing residencies is problematic," she said. 2. Medicare rates continue to stress hospitals. A majority of Republicans in Congress oppose the current Medicare program, signaling the likelihood of major change in the program. For years, low Medicare reimbursement has wreaked havoc on hos- pital margins while still adding to the country's debt. The sustain- able growth rate was abolished in 2015 and could be replaced with a voucher system as outlined in Speaker of the House Paul Ryan's healthcare plan. "It's hard to know what will happen on the Medicare side," said Daniel Neufelder, president and CEO of Ministry Health Care, a Menasha, Wis.-based health system that joined Ascension in 2013. "If [the ACA] were ever going to be swept away, it would be now because there isn't a barrier keeping it there…I think the door is opening for Republican leadership to create more of a voucher system even for Medicare." 3. Collecting on high-deductible health plans. A Henry J. Kai- ser Family Foundation survey of employers shows deductibles increased 67 percent from 2010 to 2016. With deductibles in- creasing, patients are responsible for a larger portion of the bill and hospitals must collect directly from them. Additionally, the average health plan premium for plans purchased on the ex- change increased 25 percent this fall, according to the Obama administration, and it's unclear what effect Mr. Trump's health policies will have on patient contributions. "Regardless of the insurance plans, I can't collect the deduct- ibles," said Rick Allen, CEO of Warren (Pa.) General Hospital. "Whoever is providing the coverage, it doesn't matter the sce- nario — ACA or high deductible plans — it's impacting our com- munity. We are viewed as the bad guy because we are trying to collect their payment. As a small community hospital, we need Sponsored by:

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