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Friday Plenary Session

Posted By Matthew P. Martin, Tuesday, October 24, 2017

If you missed the Friday morning plenary session at the 2017 CFHA Annual Conference in Houston, you missed a fantastic presentation by Len Nichols, PhD, Professor of Health Policy at George Mason University. Dr. Nichols described how we got to the current state of affairs in healthcare and what reform may look like in the near future. He mixed policy talk with humor and wit, offering a delightful experience for conference attendees.


Current data, according to Nichols, shows that the number of uninsured dropped by one third following the implementation of the Affordable Care Act. National health spending increased from 17 to 18% while readmission rates went down as hospitals began identifying and addressing social determinants of health. However, Nichols reports that some hospitals have begun to give up on reducing readmissions suggesting that hospitals are willing to suffer the subsequent financial penalties. All these recent developments point to some progress as well as uncertainty as politicians and policymakers continue to grapple with health reform.


“So, how did we get here?” Nichols asks. He cites historical examples of Democrats, Republicans, and even former Governor Romney of Massachusetts attempting sweeping changes in healthcare regulation. He argues that the ACA or Obamacare is not socialism but draws from Republican plans in the 1990s and 2000s like Romney care (which actually demonstrated universal coverage and lower mortality rates.  But the question still looms: why did Republicans take control of Congress and the White House even when the ACA is more popular than ever? And what can we do today to move healthcare reform in the right direction? Nichols suggests that “we have to get better at explaining ourselves to others”.


There are powerful philosophical underpinnings in the healthcare reform that drive deep political divides. Examples include: Rules versus Liberty; All versus Some; Population health versus personal health choices; Compensating for disadvantages versus Reducing tax burden. Constituents have strong opinions about these ideas and tend to vote based on their beliefs. Reforming healthcare means coming face to face with hot-button issues that can sink incumbents fast.


Despite the political divide, Nichols offers several points on which we all can agree: first, healthcare and insurance premiums cost way too much; second, the Affordable Care Act is a disaster except for the parts we each individually like; third, fixing the ACA is severely complicated especially since reform can mean removing coverage for voters who have long memories come election time. Despite the fact that Republicans have complete control of the legislative and executive branches, they can’t seem to agree upon which changes to make.


Subsequently, there is abundant uncertainty and sabotage in the works. Republicans are weary of attempting reform and may be ready to give up. However, President Trump ended cost sharing reduction payments forcing Congress to make hard choices. There are now bi-partisan efforts underway to stabilize the ACA long enough to kick the proverbial can down the road. In the meantime, hospitals seem to have learned their lessons from readmission penalties while criminal justice systems are now champions for expanding treatment coverage to victims of the massive opioid crisis.


Nichols concludes with a prediction and some solutions. He predicts the CHIP will be reauthorized and that states will get more discretion to reform healthcare. He points out though that the US taxes 8% of GDP less than the average of many other developed countries. In other words, Americans are not taxed nearly as high as other countries yet we have an inbred resistance to any hike in taxation. He further points out that any future reform must invest in addressing social determinants of health and that the government must build trust between voters and representatives. Without trust, the entire experiment of a functional and free society falls apart.

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