A Post-Election Report from Pennsylvania: The ACA Factor?

The federal government promised health insurance companies that they’d be made whole by the feds if they had shortfalls while participating in ACA marketplaces. Many insurance companies have since found out all their money is not promptly forthcoming and their participation isn’t viable. And that is just one of the reasons why ACA premiums in Pennsylvania are up an average of 52% this year and only two health plans remain in the commonwealth’s health insurance exchange. In many ways and diverse places, the promise of the ACA hasn’t been delivered.

I had dinner with a self-employed friend a few weeks ago about the time he was looking at health insurance plans and prices during the enrollment period. He was upset that the cost of his coverage had skyrocketed while his choices shrunk. He said he was considering an affordable faith-based insurance model that allowed him to avoid paying the ACA fine for not having coverage at all. I sent him Hank Stern’s Health Wonk Review article posted a few weeks ago that lent some support to his decision.

Pennsylvania has been a Democratic stronghold for decades and was expected to be a shoe-in for Hillary Clinton. The pundits will be analyzing the data for a while trying to make sense of the outcome of this election. At this point, I can’t say that the ACA cost the Democrats the Keystone State, but when every single vote counts it didn’t help, either.

The repeal-and-replace message resonated with a lot of people who feel the sting of the ACA in their pocketbooks and in their choice of providers and plans.

For those who live in the echo chamber that is Washington D.C. and academia, they don’t hear, see or feel what impacts many of those who live outside the Beltway but have to live by its laws, fines and penalties. When the ACA was passed, not one Republican cast a vote for it. The electorate was so angry that those who had voted for it were afraid to return to their home districts for holiday. Those voters just had their day.

Now What?

No matter who won on Tuesday, it doesn’t change the fact that our country is facing hard times and difficult choices. People who pulled the lever for “anyone else but” registered frustration at the state of our country and our world. In fact, one could argue that the winner would actually be “The Biggest Loser.” One of the many daunting challenges facing our 45th president will be to create an affordable healthcare system that works. Repeal-and-replace is a skeleton plan that lacks substance and detail. Over the next few months, as the new administration takes shape, I expect President-elect Donald Trump to assemble a council of expert advisors who can provide that substance and detail. He is a businessman, and he has been successful, which leads me to believe perhaps he is open to wise counsel.

A great outcome would preserve the best of innovation and technology, and throw overboard reams of regulations that hamstring doctors and require payers, providers and patients to jump through hoops that don’t improve care or add anything to the wellbeing of patients.

I have long been an advocate of the promise of healthcare technology. Going forward, any government efforts should preserve our progress toward interoperable electronic patient records and robust data capture that can continue to inform research and patient care. We should throw overboard regulations that require providers to show they are meeting arbitrary targets that interfere with their ability to provide patient care and threaten them with reduction of reimbursement if they don’t participate.

Biotech stocks reacted favorably to the election results, and I expect companies offering cost-effective, technology-enabled solutions will do well going forward notwithstanding the overall direction of the stock market or general economy. Beyond that, the people who have the ear of the Trump administration’s transition team will provide clues about what the meat on the bones of the repeal-and-replace skeleton will look like.

As for those who voted thinking that it can’t get any worse, let’s hope they are right.


One Response to A Post-Election Report from Pennsylvania: The ACA Factor?

  1. I think there is a conundrum. The ACA wanted to extend coverage to the uninsured and also bend the cost curve. I think 20 million more got health insurance because of the ACA, which is a success. However, the flip side is the escalating costs that ensured. The cost increases are real and for people who already had coverage, absorbing huge increases that could be traced to the ACA was a bridge too far. I also think the GOP have underestimated how popular certain parts of the ACA are. You cannot bring cost down without undoing the parts of the ACA that have become popular. My sense is that rather than repeal, they will let it die a slow death and let things return to pre-ACA days, which means millions will lose coverage they just got. How those people also react will be interesting.

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