The Affordable Care Act (ACA) has been a magnet for heated Beltway conversation since inception. Health cost, benefits, and perceptions fueled debate on the future of the nation’s nascent “insurance for everyone” program throughout the elections. Yet, the surge in ACA enrollment during the Obama Administration’s last weeks signaled that for the uninsured, “getting on the train” was far better than being left behind at the station with no coverage.
Some within the health industry wonder what the future has in store post-ACA repeal. The ACA is certain to go away. However, the plan that is expected to rise in its place will likely offer similar patient-centered benefits. The big change will be giving ACA customers and small businesses more competitive choice in plans and options. It’s possible that employee health benefits will feel more like an allowance to purchase from a menu of services rather than a prix-fixed plan. For corporate leaders and communicators, the pressure will be on to educate and demonstrate value to a skeptical customer base.
President Trump says the biggest changes will not target patient benefits; rather, that health sectors must face price competition and that universal healthcare is a consideration. The ways to make that possible are many. For plans, it will be the freedom to cross state borders to market insurance. For biopharma companies, the red flag is Medicare- and Medicaid-direct price negotiations.
The changes ahead may be a mystery. Yet, Congressman Price’s “Empowering Patients First Act,” Speaker Paul Ryan’s “A Better Way” plan, and Vice President Mike Pence’s health advisor CMS-director nominee, Seema Verma, offer insight. Pre-existing condition coverage, a topic for societal angst, will find its way into the new plan. Likely, the 26-year-old and under coverage conversation will also have favorable outcome. That is not where policy changemakers are focusing their attention.
Healthcare Costs, Drug Pricing, and Access Considerations
Pharma and health insurance plan marketing and public relations teams should be evaluating how tax credits based on age and health-savings accounts will influence communications plans and patient advocacy. Patient advocacy groups should be studying and communicating how choice impacts access to treatments for specific illnesses.
Everything centers on how cost influences the national economy and Federal and State debt burden. The pharma industry will be well-served to think about retooling its drug pricing model. Insurance plans will need to draw from the retail model and improve their customer-service touch. Patient groups will need to better understand and communicate how insurance influences care access. Each of these sectors has corporate stars that have done this well and chose to lead rather than be pushed to act. Watch those companies and follow.
The new administration promised change. What is certain is that even without an in-depth understanding of whether the cost of a medicine or service is worth its price, everyone expects to pay less for more—for everything. Therefore, no longer is pitting sector against sector a workable approach. CEOs will need to partner with other health sectors to shift the big conversation from product/service cost to value-based patient care.