By Natalie Simms
Local healthcare providers and lawmakers will be keeping a watchful eye come January as President-elect Donald Trump takes office with the promise of making big changes to the Affordable Care Act. Officials with Floyd, Redmond and Harbin Clinic believe big changes are coming and hope any replacement plan continues to meet everyone’s needs.
Trump has named U.S. Rep. Tom Price, R-Ga., to be his Health and Human Services Secretary and Seema Verma, a healthcare consultant from Indiana, has been tapped to head up the Centers for Medicare and Medicaid Services. These two are well-known to have a very different opinion to healthcare reforms than the current policies.
Trump has promised his goal will be a repeal of the ACA but what it will be replaced with is anyone’s guess and one that local providers will be carefully watching.
“Most analysts expect a repeal of the ACA will negatively impact hospitals,” says John Quinlivan, chief executive officer of Redmond Regional Medical Center. “One of the biggest financials lifts for hospitals under the ACA was expansion of the Medicaid program. Since Georgia never expanded Medicaid, we never enjoyed that financial lift and consequently won’t experience a loss if that part of the program goes away.
“The unfortunate thing is we still have this large population out there who don’t qualify for Medicaid and are unable to afford other coverage. I expect President Trump, his HHS nominee, Dr. Tom Price, and CMS nominee, Seema Verma, to recognize this as a problem they need to address.”
Floyd Medical Center President and CEO Kurt Stuenkel agrees there would need to be some new system in place to help provide health insurance coverage.
“There are about 20 million nationwide and some 15,000 in our service area that are covered under one of the (Health Care) exchange products. Those people would still need to coverage,” he says. “We don’t know what the new system will be yet but there will be lots of discussion and there would be a transition period from one system to another. The transition will need lots of consideration…those 20 million people will still need healthcare coverage. Healthcare is a huge part of the economy.”
Dr. Ed McBride, chief medical officer of Harbin Clinic, says they continue to see a growth in the number of patients, both prior to and subsequent to the passing of the ACA. They have also experienced an increased administrative burden for more medical review and extended approval process for treatment due to new regulations.
“The impact we are seeing to medical decision making comes more from payers including CMS taking a hands on approach to the review and approval process for evaluation and treatment involving their beneficiaries. The result is an increased demand on staff time to submit information to payers specific to prior authorizations before patients can receive the indicated care or undergo appropriate testing,” he says.
So, what would a new healthcare plan look like? Right now, that would just be a guessing game, but there are several ideas that many providers see as viable options.
“All of us in healthcare in Georgia will be watching what happens in Washington. I do expect the exchanges to go away and possibly the subsidies. The ACA, which I did not support , was created though because of a health care crisis. I certainly hope there is a plan in place before and if the ACA is repealed,” says state Sen. Chuck Hufstetler, R-District 52. “Simple repealing the ACA will just put us back in the crisis we were in before. We have now 20 million additional covered under the ACA and any changes will need to account for how these people get their health coverage.”
One proposal supported by Trump and Vice President-elect Mike Pence is giving states ‘block grants’ to fund healthcare programs such as Medicaid. Block grants “encourage innovation that better delivers health care to eligible residents,” according to a statement from the Trump transition team.
“Our governor has wanted block grants to shape Georgia’s own program and Mike Pence recently said that block grants would be available under the new administration. So perhaps there will be a program that Georgia can buy into,” says Hufstetler.
Stuenkel also believes block grants would be beneficial to Georgia. “I think they would appeal to the state of Georgia so that we could administer the program as we see fit. But at this point, we will just be watching to see what proposals get traction.”
Another idea is an increase to benefits of using a health savings account with a high deductible insurance plan.
“I’ve always been a big fan of health savings accounts (HSAs), especially in combination with high-deductible health plans. These arrangements provide insurance coverage for serious or catastrophic events with HSA savings to cover deductibles or minor expenses. HSAs give us all an incentive to use our health coverage prudently,” says Quinlivan.
McBride adds, “High deductible savings accounts and their associated insurance plans seek to raise the patient’s overall awareness specific to the cost of care while also providing a vehicle by which individuals may accrue savings over time that will later be used to offset the cost of future healthcare needs. Unlike savings held within an FSA where unused savings are forfeited, an HSA would allow the savings to accrue over time. These types of plans can serve to empower patients to play an active role in their healthcare which overall is a very good thing.”
Whatever the plan, Hufstetler believes preventative care is ultimately the only way to see savings.
“Whatever the plan the most important part will be preventative care. This is about the only way we will see savings. Kentucky has used the money and has increased flu vaccines, colorectal, breast and cervical cancer screenings, cholesterol, preventative dental, and Hemoglobin A1c (diabetes) screenings by over 100 percent. This will bring savings down the line,” he says.
“We won’t savings until we do a better job of getting primary health and mental health care to more people. About 50% of healthcare costs are because of smoking, obesity, diabetes and hypertension. We have to move healthcare into more of a preventative care mode for everyone to achieve long term savings in healthcare.”