The Trump presidency has been a turbulent one to say the least. The process of attempting to make good on his promises has been a rollercoaster of emotions for Americans, with events unfolding in disarray as the latest White House administration looks to put its own spin on foreign affairs, immigration, education and health care. In our January 2017 issue of the Greater Lansing Business Monthly, I touched on the forecasted changes to health care in relation to President Donald Trump’s pledge to abolish former President Barack Obama’s Affordable Care Act (ACA). Since then, so much has changed and will continue to change as our nation embarks on what may be the most ominously alarming timeline since Watergate — below is a discussion about where health care is now and where it is headed.
Essentially, Trump promised within his first 100 days in office to change the way that health care is provided to Americans; that promise centers on the idea that each citizen should retain his or her ability to be proactive in choosing the right coverage, while leveraging more flexibility to insurers and pricing. Officially unveiled on March 13 under the name, the American Health Care Act (AHCA), a weight of curiosity was lifted following a rating by the non-partisan Congressional Budget Office (OBC).
From a quick view, the bill seems to accomplish many of the goals that the Republican Party (GOP) aims to accomplish in terms of reducing the nation’s deficit and providing additional savings measures thanks to cutbacks on special interest group funding. However, the morality of these budget cuts and their impact on the nation has left a bitter taste and a lump in the throats of many, regardless of which political side people are on.
While more flexibility in coverage remained a selling point, there was no way to hurdle the concern that an estimated 14 million people would seemingly lose coverage of any type. Noticeably, any mention of coverage for preexisting conditions, a staple of the original ACA, was missing. When it came time to vote, the GOP was ultimately divided, with many voters recanting their pledge of support the night before. House Speaker Paul Ryan (R-WI) pulled the bill once it became clear that it would not receive enough votes to pass.
“I will not sugarcoat this. This is a disappointing day for us,” said Ryan during a press conference on March 24 that followed his decision to pull the bill. “Obamacare is the law of the land, it will remain the law of the land until it’s replaced. We are going to be living with Obamacare for the foreseeable future.”
Taking Another Stab At It
Following distaste from both sides in Washington, the GOP went back to the drawing board on how to repeal and replace Obamacare. U.S. Rep. Fred Upton, representing Michigan’s 6th District, a formidable opponent of the initial bill, suggested an updated version was in the works. This new bill would address the concerns many had regarding the dismissal of coverage for preexisting conditions by guaranteeing $8 billion be set aside over the next five years for financial assistance.
After a period of waiting, many came to expect the new bill to address the missing link of the initial version. However, in April, what is now known as the MacArthur Amendment was presented – named after its primary author, U.S. Rep. Tom MacArthur (R-NJ).
Despite the reluctance of Republicans who felt the new bill only made updates rather a true repeal and replacement as intended and promised, the U.S. House of Representatives passed a proposed bill with a narrow vote of 217 to 213. Officially mandating the beginning of a long journey to final approval; the bill must now pass the U.S. Senate before officially becoming law, pending a signature from Trump. Because of continuous discouragement, including widespread statements of resistance from AARP, the current bill has received additional alterations from Republican Senators and must now be debated by a committee of state senators before going to a final vote. In a last stand, so to speak, senators bring hope to special interest groups like Planned Parenthood, AARP and a flurry of other organizations that stand in opposition.
So, what does this all mean for average health care consumers? Should we be worried? To answer a few of the questions on the onslaught of changes we might see in the near future, we’ve turned to Thomas Mee, president and CEO of McLaren Greater Lansing.
Surely you’d assume that an overhaul of such a detailed and complex system such as national health care must come with some obstacles. However, according to Mee, the new bill would do very little from a provider’s perspective to alter how accessible health care services are and how they’re being provided.
“From a purely operational perspective, the proposed changes under the “new” ACA have very little impact on the delivery of acute care in the hospital setting,” explained Mee. “In fact, with or without the “new” or “old” ACA, our providers are largely blind to the insurance status of the patients they are serving, which is precisely the way I want it to be. Our motto ‘Every Patient, Every Time’ is, by design, ignorant to payer status or socioeconomic standing. Every patient will receive best in class service, irrespective of insurance, every time.”
Moving forward, one of the biggest hurdles hospitals and other providers will face is their ability to provide long-term and specialized care to the newly uninsured. While no patient can be denied treatment, this doesn’t mean these individuals’ wallets or financial standings won’t take a punch. McLaren is forecasting the potential impact of these changes, and the ways the changes might ultimately impact their ability to advance.
“We anticipate a resurgence of bad debt and associated write-offs as we expect to see the number of uninsured grow, as we experienced prior to the first ACA,” said Mee. “It’s glaringly obvious that any economic environment that results in increased, uncompensated care means that hospitals will have less funds to reinvest in new technology, updated facilities, human resource compensation adjustments, etc.”
Sitting alongside those concerned for the uninsured are advocates for the firm recognition of mental health coverage. As decade-spanning research comes to fruition, many see mental health as unrepresented. In addition to cuts in Medicaid and a reduction of funding toward premium costs for treatment of pre-existing conditions, this has been another missing link in the minds of providers — both for the new bill and the current ACA.
“I think that both reform acts were woefully and embarrassingly absent of support for the populations of patients suffering from behavioral health conditions,” remarked Mee. “Our lawmakers, with relatively few exceptions, have ignored the plight of people suffering from mental health issues. The result is that the acute care hospital is left with the responsibility to care for these individuals and, quite candidly, few are equipped to do so. There exists a mental health crisis in this community and in the country as a whole; it’s increasingly frustrating that it appears no one wants to address the root causes of this.”
With so much left to be determined and a multitude of potential amendments on the horizon, there’s simply no way of telling if the proposed ACHA will see the light of day. As such, providers are afforded little opportunity to help assist their patients in planning for changes. Instead, they’re urging people to take the time to educate themselves on what’s at stake, their health status and all care options at their disposal. It might be time to consider thinking outside of the box.
“Patients, in general, irrespective of income or socioeconomic standing and insurance status, must take a greater level of ownership of their health care delivery,” said Mee. “There likely exists no other industry where consumers spend less time researching not only their health condition, but the intricacies of how that care is delivered and at what cost. The new paradigm of the high-deductible health plan is likely not going away under any health care reform effort, and consumers shouldn’t be hesitant to inquire as to the costs of service and, most importantly, the quality metrics associated with their physician or hospital provider.”
While a new health care plan may seem inevitable, it may take a while to get real reforms passed; the process thus far has been lengthy and clouded by political bloat. If the Trump administration and the GOP want to uproot the former president’s most sacred health care law, it will take time, diligence and finesse. It won’t be a simple journey but, fortunately, there are strong proponents on both sides of the aisle in Washington looking out for what’s in the best interest of American consumers.
This article was crafted using information that was accurate as of June 22, 2017. Greater Lansing Business Monthly will be updating the digital version of this story as it progresses. For future updates visit lansingbusinessnews.com