09 Nov 2018 D.C. gridlock means the rest of the country can get on with life
Often, a Congressional gridlock is essentially good. The reason being the executive arm of government is forced to always consider a bipartisan approach to issues if it’s to secure the approval of both Democrats and Republicans in Congress.
The outcome of the midterm elections indicates that the Republicans have managed to retain their control of the Senate, while Democrats have secured control of the House of Representatives.
Health a Central Issue During the Midterms
According to a survey by Health Research Incorporated, Health followed by Social Security and Medicare were the three top issues of concern during the midterm elections with 59% of the respondents irrespective of age, race or geography citing health as the most significant.
Among Trump’s electoral promises was a complete repeal and replacement of Obamacare under the Affordable Care Act (ACA) with a policy that was apparently less expensive and more effective. On his first day of office, Trump signed an executive order, instructing federal agencies ‘to take all reasonable measures that minimize the economic burden of the law, including actions to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act.’
Trump’s administration has further repealed the individual mandate and promoted short, limited duration plans, meaning fewer Americans can access plans that cover their basic needs. Federal government spending on ACA has also been reduced, with federal government halting the payment of subsidies effective January 2019 and funding for the promotion of ACA stopped. In addition to the preceding, twenty states including Texas are in the Supreme Court challenging the coverage of pre-existing conditions under ACA citing increased costs to the state governments.
Midterm Election Outcome Implications Concerning Health Policy
For insurance companies, the unpredictability over the fate of ACA has meant that premiums were also unstable, with periodic spikes to the detriment of most Americans. At first, ACA resulted in an increase in the number of Americans paying premiums, especially healthy young Americans enabling the companies to profitably extend cost-effective premiums to poor and sick Americans who could not otherwise afford coverage. However, Trump’s series of amendments undermine the incentive for insurance companies to provide coverage to high-risk individuals who are the most vulnerable – the old and sick.
Going forward, additional changes to ACA with a Congressional gridlock will be highly unlikely. It’s a perfect time, then, for states, consumers, health service providers, and insurers to attempt innovative approaches that they’ve been putting off due to the uncertainty over the future of ACA. Insurers should consider options for adjusting care provision models to make them less vulnerable to shocks that drive premiums up. For instance, looking for ways to promote good routine care and healthy habits will contribute to a well-contained risk pool, as prevention measures cost reasonably less than curative.
Health service providers can also take advantage. Changes to how a practice works or the services it can offer take time to implement and often have setup costs. Many around the country may have put off changes in the past 2 years, and will now see an opportunity.
This will obviously have a significant impact on consumers too, with the potentially new, or improved approaches and services that will be offered in their areas. Hopefully, the next two years will see an improvement in the accessibility and affordability of care.
All of these opportunities invite an expanded role for telehealth. Shifts in the ways we deliver health services are often approached with great care even if they are for the better. Telemedicine is usually no exception. Insurers need ways of verifying the reliability of the technology used. That takes time and resources.
Though, some technologies, like Toothpic, integrate easily into an existing office setup, with only software to install. Others require new hardware and training on how to use it. The trade-off is that they give the providers a broad scope of services that can be offered remotely. For example, the ability to monitor the care of multiple patients remotely is an option open to doctors now – but the hardware isn’t necessarily cheap.
In all cases, transitions take time. It takes time to train people, to adjust to new services, or just to get used to things. That is the most favorable result from the split in D.C. Now people can take that time, confident the healthcare world won’t be turned on its head in 3 months’ time. It’s an opportunity for people at all levels of the healthcare landscape across the country to be more imaginative and find new ways to help the system work better.