Health Policy in Washington and the States: A Look Ahead

Three months following the 2018 midterm elections, a panel discussion at AcademyHealth National Health Policy Conference, held February 4-5 in Washington, DC, outlined how much healthcare did, or didn’t, play a role in the elections, as well as what healthcare trends to expect in 2019.

Looking at results from the midterm elections, they weren’t heavily based on healthcare, explained Melinda Buntin, PhD, professor in the department of health policy at Vanderbilt University Medical Center. Instead, a majority (66%) of voters indicated that their vote was in support of or against the president.

And instead of wanting the elections to bring change to healthcare, voters largely wanted healthcare to stay the same. Looking at results from a poll from POLITICO and the Harvard T.H. Chan School of Public Health, “people agreed they wanted Medicare benefits to stay the same, they didn’t want people to lose their health insurance, they didn’t want people to not be able to get health insurance if they had a pre-existing condition,” said Buntin.

But what were they concerned about? According to a Hart Research poll, voters did express concern about healthcare costs, noting prescription drug costs in particular. Voters also demonstrated more awareness of surprise billing, with 2 out of 3 respondents of a Kaiser Family Foundation health poll indicating that they are actively concerned about getting an unexpectedly high medical bill.

“Everyone is thinking about costs, and I think it’s safe to say Winston Churchill was right about America: we will do the right thing after we try everything else,” said Len Nichols, PhD, director of the Center for Health Policy Research and Ethics and a professor of health policy at George Mason University.

Buntin predicts that Congress will focus on these high prescription drug costs and surprise medical bills, both of which seem to have bipartisan support. She mentioned some stakeholders touting the idea of tying surprise out-of-network bills to the Medicare fee schedule in some way.

Hemi Tewarson, director of the health division of the National Governors Association, also expects more conversation around a drug pricing index, which the Trump administration has proposed to help Medicare drive down the costs of prescription drugs by basing prices for certain drugs on what other countries pay.

But addressing costs is both complex and complicated, said Nichols, so where else can efforts be focused? In end of life care and social determinants.

Social determinants are at the forefront of conversations surrounding improving healthcare delivery and outcomes, which stemmed from readmission penalties, explained Nichols. When these penalties were introduced under the Affordable Care Act, hospitals began to look at ways to reduce readmissions and landed on these factors that occur outside of the doctor’s office or the hospital. Another driver has been the opioid epidemic, which Nichols called “the poster child of social determinants of health.”

Another trend likely to continue, and grow, in the coming year is more action being taken at the state level, agreed the panel members. Grace-Marie Turner, president of the Galen Institute, cited the Trump administration giving more flexibility to the states through waivers, including 1332 waivers, as well as through short-term limited-duration health plans and Medicaid work requirements.

Tewarson pointed to states taking the lead on importing drugs from other countries. For example, in May 2018, Vermont introduced legislation that would allow the state to import drugs from Canada. Last month, Senator Chuck Grassley, R-Iowa, and Senator Amy Klobuchar, D-Minnesota, introduced a bill that would allow people to buy drugs from approved pharmacies in Canada.

States are also looking at integrating behavioral and physical health, according to Tewarson. “There’s understanding that if you can address the behavioral health needs of the population, their physical needs will decline.”