Marianne Udow-Phillips considers the last few years an “interesting time in health care because it’s always hard to predict exactly what’s going to happen” under President Donald Trump. The executive director of the Ann Arbor-based Center for Healthcare Research & Transformation, Udow-Phillips hopes that what happens in 2020 is a greater push to better controlling ever-rising costs in health care.
What’s the biggest issue for Michigan’s health care industry in 2020?
The biggest issue is a continuation of the big gorilla in the room, which is the cost of health care. Everybody’s been looking for what the magic bullet is and we’ve gotten to the point in health care where so much of the cost has been transferred to consumers in the form of co-pays and deductibles and these high-deductible health plans, and that’s kind of run its course. That is not going to be an option going forward, yet we still have the cost of health care as a major issue.
What are some tactics to combat rising costs in 2020?
On the positive front, more employers are understanding the connection between human service issues and the cost of health care. We do have a lot of people who end up in the emergency department of hospitals, but they really are there because they’re dealing with issues related to substance abuse or mental health issues or other issues. If you could deal with them on the front end, on the upstream, you could keep them out of the emergency department. So on the positive end, we hear more health plans — and more purchasers and employers — talking about what’s known as social determinants of health. What do we do about those kinds of critical issues?
Employers are looking for a lot of different strategies. Some of them do say maybe we should think about concierge medicine or direct primary care, or something like that. There’s no data out there to show that saves money, but I think it expresses an idea that employers are frustrated with what the choices are and are really searching for anything.
What could we see in the state Legislature next year to address health care issues?
I do think we’ll see movement in our state on price transparency bills, particularly when it comes to prescription drugs. Drug transparency is on the agenda in Lansing for sure. Surprise medical bills are still on the agenda in Lansing, and that is a critical issue. There does seem to be bipartisan support to do something with surprise medical bills, and that’s also moving at the federal level.
What do you want to hear the presidential candidates talk about in their campaigns?
I really want them to focus on this issue of the cost of health care. We’ve gotten way off in this discussion on Medicare for All and other approaches on financing that miss the core issue that consumers really care about, and that is they are paying too much for their prescription drugs. So I really want to hear the candidates focus on what they would do about the cost of care.
What’s lurking over the horizon that makes you worry about 2020?
No question, this Texas lawsuit makes me worry because it will be so disruptive to the health care system (if the Affordable Care Act gets overturned). [EDITOR’S NOTE: As this report went to press, a federal appeals court ruled the individual mandate was unconstitutional, but sent the case back to a lower court to decide what parts of the law can stand.] Sure, it would go to the Supreme Court and who knows exactly where it would end up, but it would throw so much chaos into the system and we need predictability. We need people to have a system that they understand and that continues to function. That lawsuit and some of the other efforts that have been attempted to undermine the Affordable Care Act really create business uncertainty and sow a lot of chaos in the marketplace.
What makes you think some of the problems with health care will get a little better?
This positive trend I see of health plans recognizing the connection between social determinants of health and the costs of health care. That’s huge, and that’s been a long time coming — the fact that we’re now even talking about those kinds of issues and that there are efforts underway to think creatively about what health benefits could look like in the future that might address some of those problems.
What would surprise you in 2020?
If we pass a federal bill on prescription drug costs, that would surprise me. That would be a good thing, but it means that we have overcome a huge lobby in Congress. If there were more coming together of Democrats and Republicans on ways to fix the Affordable Care Act and move it forward to create more access for people, that would surprise me and it would be a good thing.