Continuing Forward With Innovation and Progress in US Healthcare

Healthcare is a complicated issue with few, if any easy fixes. The important thing is that the country continues to move forward and does not move backward, according to panelists during the first plenary at the ISPOR 22nd Annual International Meeting, held May 20-24 in Boston, Massachusetts.

The panel was made up of 2 individuals who have advised Republicans—Gail Wilensky, PhD, of Project HOPE, and Joseph R. Antos, PhD, of the American Enterprise Institute—and 2 who have advised Democrats—Jonathan Gruber, PhD, of Massachusetts Institute of Technology, and David M. Cutler, PhD, of Harvard University.

Wilensky’s largest concern is that although changes are made to health policy and Republicans work on repealing parts of the Affordable Care Act (ACA), the substantial inroads that were made in reducing the number of uninsured individuals in the United States will be lost.

“There are other issues to deal with, but I’m somebody who strongly believes that having insurance coverage is important…” she said. “Whatever we do going forward, I don’t want to lose ground.”

Cutler added that his concern is that the small movement being made toward trying to reconfigure US healthcare to be delivered in a way that results in better outcomes is going to get caught up in the push to undo the ACA.

In the Republican efforts to repeal the ACA, they missed out on “some fairly straightforward changes that could be made to better stabilize the insurance market,” Antos said. For instance, the 2 big goals in healthcare are lower costs and more choices. Lower cost has been part of the rhetoric of the ACA, and it became apparent that this was difficult to do. However, more choice is something Republicans could have had more control over, he claimed, but they didn’t follow through.

In fact, all panelists agreed that the Republican Party has “induced turmoil” in the ACA markets. Antos said he found the idea that the marketplaces were in a death spiral “questionable” and that the implosion politicians keep referring to “certainly isn’t there.”

Cutler noted that the insurance markets had begun stabilizing in 2016, with some insurers making profits as they corrected for who was enrolling.

“The Trump administration has created an enormous amount of confusion” by threatening to not fund the cost-sharing reductions and by not requiring people to report on their tax returns if they had insurance. “Insurers are now thinking again that every change out of Washington will cause them to lose money.”

Wilensky pushed back a little on the claim that the markets had stabilized in 2016 because there were still markets that only had 1 insurer, there were still larges increases in premiums, and insurers had small profit margins.

“We weren’t really at an acceptable place in 2016, but we are now in more turmoil in 2017,” she said.

Even if Republicans in the House and Senate can agree on a healthcare bill and get it passed, which is not guaranteed, according to Wilensky, the ACA will still remain the law of the land for a couple of years until there can be a transition to the new law. As a result, she does not believe it is in the interest of Republicans to purposely destabilize the market more than it had done on its own.

A few months ago, before the presidential election, Gruber believed that even if Republicans controlled both the House and the Senate, they wouldn’t be able to pass an ACA repeal. Now he doesn’t know, but he does believe the Senate has a tougher road than the House.

Wilensky echoed that belief, adding that Republicans are currently doing all the things they faulted Democrats for when passing the ACA by ramming a bill through on single party support. She finds it unbelievable that the GOP doesn’t realize that they won’t be faced with the same thing Democrats faced in the wake of passing the ACA: opposition to every piece of legislation and losing races at every level of government.

Gruber added that Republicans are making the situation worse for themselves. When the ACA was first being drafted, Republicans were on committees to draft the bill. “There are still parts of Obamacare that were put in by Olympia Snowe [former Republican senator from Maine] and her staff.” It was only once Republicans went to town halls, where their constituents were furious, that all Republicans jumped ship and refused to vote for the bill, he explained. Right now, Democrats aren’t being engaged at all.

The discussion also turned to drug pricing, investment in pharmaceutical research and development, and government regulation. Although there was some disagreement regarding the particulars, the panelists all agreed that there are no easy answers, and any solutions will be difficult to create and implement and take a long time to make any impact.

There is unlikely to be any quick fixes, Gruber said, but the focus should be on whether or not the country is innovating and moving forward.

“It’s a big tanker to turn around,” he said. “We don’t have to turn it around right away.”