With the 2018 midterm elections in the rearview mirror, the business of healthcare continues its journey toward becoming 20% of the U.S. economy.

However, the past two years of “politics over policy” bluster coming out of Washington’s healthcare scene isn’t going to come to a sudden stop. As Democrats take control of the House of Representatives, the next two years may be no less volatile, but the healthcare agenda will shift focus. Let’s not forget, over 40% of midterm voters said healthcare was the top issue facing the country far ahead of immigration and the economy.

While Congressional gridlock and legislative logjams will impede progress on health policy, several key election takeaways will shape the debate:

Affordable Care Act

Proclamations that “repeal & replace is dead” are likely true, but don’t underestimate the Trump administration’s continued sabotage and neglect of the Affordable Care Act (ACA—aka Obamacare), either through Executive Order or Tweet. In spite of 70 failed Republican-led attempts to repeal the ACA, we’ve seen the individual mandate eliminated, funding drastically slashed for consumer outreach and enrollment support, and Trumpcare’s push for low-benefit “junk” insurance plans. So far, the only result of this political vandalism has been an uptick in the number of uninsured Americans. Expect Democrat and Republican jockeying to continue in Congress, in the courts, and in the media—a lot of noise with little progress.

On a shorter horizon, two issues will gain traction inside both parties. 1) Resolving the fight around the election’s most high-profile healthcare issue: Protections for people with pre-existing medical conditions. 2) Guarding patients from surprise “shock & awe” medical bills, such as extreme charges from using out-of-network providers.

Government Programs

For government entitlement programs covering approximately 60 million Medicare beneficiaries and 70 million Medicaid recipients, large-scale reforms are not likely in a Democrat-led House—even as Federal budget deficits circle $1 trillion.

Medicare: With more than 3.5 million Americans turning age-65 every year, popularity of Medicare Advantage, Part D Prescription Drug Coverage, and Medicare Supplement will continue. Democrats won’t risk igniting a Boomer revolution by tampering with Medicare (or Social Security).

Medicaid: The midterm election saw voters in three states approve Medicaid expansion, opening-up program eligibility to cover more than 300,000 additional low-income people. Additionally, with the election flipping at least seven Governorships from Republican to Democrat, expect to see even more Medicaid expansion in 2019.

Medicare For All

Another healthcare issue to surface during the midterm election cycle is the emergence of “Medicare For All” as the new hot potato of the single-payer debate. Brought to the forefront in the last few years by political progressives, “Medicare For All” still lacks consensus around a definition. For some, its pure government-run healthcare, for others it’s a public-private partnership, and for yet others, it means simply letting those under age-65 buy-in to the current Medicare program. Leading up to the 2020 presidential election we’ll see robust debate around healthcare policy issues and reform options including “Medicare For All,” but don’t expect legislative movement any time soon.

Drug Pricing

Maybe the closest thing to a bipartisan healthcare issue is finding a fix for the rising cost of prescription drugs, a high-visibility issue in Washington. Under the veil of “transparency,” the administration recently proposed price disclosure advertising requirements for prescription drug manufacturers. Additionally, in a controversial move, Trump has proposed reducing the price of certain costly drugs in the Medicare program by linking payments to what other industrialized countries pay. Expect Democrats to push for more aggressive drug price controls as well as direct price negotiations on Medicare Part D drugs.

Payers, Providers, & Pharma

For healthcare payers and providers, it’s far from business as usual. Markets such as ACA, Medicare, and Medicaid are changing rapidly. Traditional product-lines are being commoditized, competitors are consolidating for efficiency and scale, and healthcare consumers are hyper-focused on access to care and cost—the annual price of health insurance has topped $28,000 for a family of four. In today’s out-of-pocket healthcare ecosystem, one-in-three Americans claim healthcare is their biggest financial burden, leaving 29 million Americans uninsured. Combine this with an increasing number of healthcare delivery choices and it’s no surprise that navigating complexities of the healthcare system’s maze of bureaucracy is more onerous than ever. Creative marketers can play a critical role by designing reliable, relevant, and practical information bolstered by consumer-centric decision support tools.

In the $500 billion prescription drug sector where consumer “trustability” is at an all-time low, pharmaceutical pricing issues loom large. Whether price transparency, negotiated deals, PBM rebates, or new Medicare reimbursement rules, something’s gotta give. The challenge for marketers is that communication, education, and advertising will get even more complicated than it has been—and more scrutinized. Consumers are confused and uncertain about the future of their healthcare, particularly drug price variations and inconsistencies. Accuracy and clarity will be paramount, especially since price is a direct hit to the family budget. With drug prices in everyone’s political crosshairs, finding the “right” middle-ground will be key to moving the needle in improving big-pharma’s healthcare consumerism image.

Implications for Marketers

As healthcare consumer expectations align with their retail experiences, they are taking a more active, engaged role in their health. The retailization of healthcare is here to stay. Marketers must recognize that to influence the healthcare customer lifecycle—awareness, shopping, engagement, experience, and loyalty—takes a different, more diverse mix of brand, direct, and content marketing. Personalization will separate winners from losers.

In today’s contentious political landscape, healthcare brands have an opportunity to emerge as trusted community resources helping customers take ownership of their health by supporting value-based financial and clinical choices. Motivating and empowering people to manage their health is a place where the industry has traditionally fallen short, and is an area we research in our annual Health Inertia Study. When done well, brands can replace consumer insecurity with healthcare confidence. It’s up to savvy marketers to turn healthcare consumers into savvy customers.

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