The Affordable Care Act withstood repeal efforts in Congress in 2017 and remains law, which has industry watchers doubting we’ll see another full-scale push to repeal and replace the Obama-era health care policy.
Instead, opponents to the ACA are more likely to continue to “chip away at it” in the year ahead, said Sarah Miller, an assistant professor of business economics and public policy at the University of Michigan Ross School of Business.
Certain aspects of the Affordable Care Act have proven popular with the public, which makes it difficult to muster the votes for repeal. They include the issue guarantee for anyone seeking coverage, federal subsidies to help buy coverage, Medicaid expansion, and provisions allowing dependents to stay on their parents’ coverage until they reach age 26.
As Congress now focuses on tax reform and in light of House Speaker Paul Ryan’s statement that he wants to move on to entitlement reform in 2018 — a midterm election year for Congress, Miller expects the ACA to remain intact as a law, although it still “will be undermined a little bit.”
“I would be surprised if we saw an attempt at another legislative repeal-and-replace effort. I would be surprised to see sort of a big health care bill be pushed next year,” Miller said. “There’s a lot the Trump administration can do to chip away at it without having this big total repeal.”
Among the parts of the law that have been “chipped away at” are a move by President Trump to halt cost-sharing payments to health insurers, resulting in large spikes in 2018 premiums for policies bought on a public exchange, and a lack of enforcement in the individual mandate that requires people to buy coverage or pay a tax penalty. The administration also shortened the open-enrollment period for public exchange policies and cut funding for marketing them.
Miller “would not be surprised” to see some sort of rollback in the mandate that requires employers with more than 50 full-time equivalent employees to offer health coverage.
The tax reform bill also includes a provision to repeal the individual mandate, which worries Laura Appel of the Michigan Health & Hospital Association.
Like Miller, Appel also sees opponents to the law in Congress continuing to fail to secure enough votes for an outright repeal but fully expects they will target certain aspects of the ACA.
The ACA has led to more people having health coverage, which has cut down on the bad debt that hospitals incur when patients are uninsured and cannot pay their medical bills.
Repeal of the individual mandate or a lack of enforcement could lead to younger, healthier people not buying their own coverage, or declining to enroll in employer-sponsored coverage. In turn, that will adversely affect insurance risk pools.
“It’s really going to have a significant impact on the individual market, and I also wonder what it will have on the group market,” said Appel, vice president and chief innovation officer at the MHA. “If you are young and feeling invulnerable, knowing that there’s no real penalty anymore, you might say to your employer, ‘Nevermind, I’m not doing this. I don’t want to pay my share of the premium.’ Which means if any sizeable number of young people in that employer group goes away, it will change that component of the employer group as well.”
Possible entitlement reform in 2018 also concerns the MHA. Entitlement reform includes potential reductions in Medicaid funding, reduced matching rates for states, or a toughening of eligibility requirements, Appel said.
The tax reform bill, should it balloon the federal deficit, could also affect Medicare if it triggers automatic cuts in federal spending.
TECH RESHAPES HEALTH CARE
Beyond what happens to the ACA, a major trend to watch in 2018 is the continued emergence of telehealth.
Dallas-based Teledoc Inc., the nation’s largest provider of virtual visits with primary care physicians, recently reported that it now works with 200 hospitals and health systems, a growth rate of more than 100 percent in the last year.
In August, results from the National Business Group on Health’s national survey on health care costs indicated that “virtually all” large employers in the U.S. will offer telehealth services as a benefit in their health coverage in 2018 in states where it’s allowed. More than half of large employers surveyed planned to offer telehealth for behavioral health services.
In rapidly adopting and rolling out telehealth, health care providers are following other industries into the use of virtual technologies to reach out and improve access and offer convenience that consumers now demand.
“Health care doesn’t operate in a bubble. Health care changes the same way society changes, and we’re seeing how technology changes and is adopted,” said Danyale Phillips, a health care attorney at Warner Norcross & Judd LLP in Grand Rapids. “Technology is allowing people to get health care in a very accessible and convenient manner. It addresses the same issues we see in everyday life. We want to be able to do things quicker.”
Spectrum Health recently launched a mobile app for its MedNow telemedicine service that has served nearly 20,000 people since 2014 for low-acuity conditions such as an infection, a rash or the flu. Available for use on iPhone or Android devices, the app allows users to schedule and conduct a virtual visit with a doctor via streaming video.
“Consumers have been asking for more and better digital engagement. The MedNow app is in response to those demands,” said Tina Freese Decker, executive vice president and chief operating officer at Spectrum Health. “Not only will the MedNow app save patients time, it also makes us more effective in delivering care when and where it is needed most.”