Health care in crisis
A symposium addresses the post-ACA landscape
Despite attempts at an overall cheery tone, the views presented during “Obamacare after Obama: The future of U.S. health care at a crossroads,” a conference held at the Memorial Center for Learning and Innovation last Friday, could not help but paint a disturbing picture of the potential short and long-term future of health care in this country.
Presented by Southern Illinois Healthcare and the Southern Illinois University Health Policy Institute, the all-day conference was described by an advance press release as offering “a multifaceted look at the ways the recent presidential election may affect health care moving forward under a Trump administration.”
Since the Patient Protection and Affordable Care Act (a/k/a Affordable Care Act a/k/a ACA, a/k/a “Obamacare”) became law in 2010, physicians, clinics, insurers and employers have all been forced to make significant adjustments. Now, in the wake of the November 2016 election, the newly ascendant Republican Party has made it clear that another set of equally cataclysmic changes is on the horizon. The GOP’s credo of “repeal and replace” regarding President Barack Obama’s signature piece of legislation has resulted in the American Health Care Act (AHCA), which faced a rocky road before being narrowly approved by the U. S. House May 4, pending unknown changes still to be made by the Senate. As press materials for this event put it, “the debate about repeal and replacement continues and grows more complex and intense…and will likely further disrupt health care providers and their patients in numerous ways.”
The first speaker at Friday’s session was G. William Hoagland, senior vice president of the Bipartisan Policy Center in Washington, D.C., who spoke on “the challenges of budgets and health care.” Somewhat sheepishly and humorously admitting his status as a Republican, Hoagland was measured in his criticism of the Trump administration’s approach to the issue but it was clear that, along with expressing some bewilderment at statistics pointing to sick people voting Republican in the election – in his view, voting against their own interests – true to his organization’s name, he held out hope that cooler heads would prevail regarding the final version of the AHCA. Hoagland wryly closed his presentation by quoting Winston Churchill’s aphorism, “You can always count on America to do the right thing, after they’ve tried everything else.”
The next speaker was Jeremy Earl, partner in the Chicago law firm of McDermott Will & Emery LLP, who spoke on the subject of the implementation of the ACA since the start of the Trump administration, who started his numbers-heavy talk by saying, “I can’t say I have given a presentation before while the ground was shifting underneath me as much as it is right now.” He went on to invoke Mark Twain, regarding the ACA, stating his belief that despite all the talk of repeal and replace, “rumors of its demise might end up being greatly exaggerated.”
Larry S. Boress, president and CEO of the Midwest Business Group on Health gave a lightly acerbic talk about “the purchaser’s view of health benefit directions,” making and frequently reiterating his primary point that, contrary to public perception, it is largely the businesses providing health care plans to employees who decide what is covered by those plans, as opposed to the federal government.
Other speakers included Leighton Ku, director of the Center for Health Policy Research at George Washington University, who provided some light doom-saying regarding the future of Medicaid; Daniel Derksen, chair and director of the Arizona Center for Rural Health, who gave a sobering perspective regarding the nature of support for Trump’s agenda among rural communities; Linda Baker of the Paul Simon Public Policy Institute, who raised more questions than she was able to answer regarding ways changes in health care legislation might play out during the ongoing budget deadlock in Illinois; and Dania Palanker of Georgetown University who provided a detailed analysis of how a post-ACA world might impact women’s health issues. She took care to point out that these encompass far more than just reproductive health, in spite of that usually being the sole focus taken by media and legislators.
The strongest statement of the day came from Hoagland, who forcefully put across his belief that the AHCA is doomed to failure in the long run, every bit as much as the ACA was, due to the blatantly partisan nature of both pieces of legislation. “Unless a bipartisan health bill is somehow achieved,” he said, “we’re just going to have to deal with one conference like this after another.”
Scott Faingold can be reached at firstname.lastname@example.org