From Stealthcare to Healthcare? A FleishmanHillard Policy Discussion
Since the enactment of the Affordable Care Act in 2009, there ensued a profound sense of déjà vu as Republican members of Congress tried to undermine the law through court challenges as well as through repeated attempts to vote a full repeal. Now in a majority in both the House and the Senate and with the Executive branch, there has been a slow drama unfolding since the election. The House had passed a bill of "repeal and replace" and for some weeks, a select panel in the Republican Senate had been tasked to work behind closed doors on a version to be voted on before the July 4 recess. The contents of the bill were to be revealed June 22, though media reports indicated there was at least a strong possibility, if not probability, that there were not enough votes even among the Republican side of the Senate to pass such a bill, particularly given the secrecy involved in its development and given the compressed timeline and lack of any public hearings before a vote.
Against that backdrop, the Washington, D.C. office of FleishmanHillard hosted an expert panel to consider the state of healthcare reform since the election, held the day before the Senate would unveil the contents of its proposal for repeal and replace.
Everyone knows that there is a lot at stake in the healthcare debate – not just for the country where the healthcare sector spans 18 percent of our economy – but in the lives of individuals. We wanted our discussion to reflect that reality. The event was titled "Healthcare in the Trump Era" and was designed with an aim to getting the point of view from experts who could provide perspective within three key pillars – the politics of the current situation, the policies and the impact both would have on the American people.
We invited three extremely well-qualified experts to do that, two of whom are former members of Congress from each party who have continued their involvement in politics in ways that could inform our discussion. We sought experts who could talk to this important subject with an understanding beyond Congress. Our panel included Jim Gerlach, former Republican member of Congress and now CEO and president, Business-Industry Political Action Committee; Allyson Y. Schwartz, a Democratic former member of Congress and now CEO and president, Better Medicare Alliance; and Matt Salo, executive director, National Association of Medicaid Directors. Three key questions guided our discussion.
Why has it been so hard to get healthcare right?
Answering this question could consume hours, but clearly the consensus was that the highly political and bipartisan nature of the way we have gone about it undermines success, even with so much at stake. And it is not unique to healthcare, Congressman Gerlach noted saying that for the past 10-15 years we have been stuck in a permanent campaign mode, no matter what the issue, and that a fundamental divide has revolved around the fundamental of how much control the government should have on any issue – and healthcare is no exception. And while healthcare has a number of issues that impact the nature of the public discourse, the fact that one's healthcare is so highly personal means that there is not only a high value proposition at stake, but a very emotional one as well. The panelists were in complete agreement that there is too much politics when it comes to discussions of policy, which brings us to the next question.
If the policy goals are being obscured by the political ones – what are the policy goals?
Congresswoman Schwartz summed it up in one word – access – access to the kind of care we need, when we need it. And while some have access as a priority, for many in Congress, it is cost containment. To that end she said that the system could go a long way in cutting cost merely by making sure that people are accessing the care in the most cost effective way. That point was echoed by Matt Salo who, representing Medicaid Directors – and after stressing the huge role played by Medicaid in providing healthcare to Americans, stated that a good policy goal would be to make Medicaid less important in the healthcare system. If we had a system of care where you don't have to impoverish yourself in order to receive healthcare and where people could access other sources of good coverage, then we would be achieving a huge amount of what we want out of a healthcare system. Greater access, less cost.
What is the impact on people?
The impact of Medicare was also present in the discussion of people – identifying who the stakeholders really are in this debate. Matt Salo emphasized that we are all impacted by Medicaid and that the extent of its role in healthcare is largely not widely understood, meaning in fact that everyone, as Congressman Gerlach pointed out, is impacted.
The tug of war in healthcare entered a new phase the day after the event, when the Republican legislation was revealed to the public, kicking off a new round of advocacy. Fatigued though Americans may be, the panelists emphasized that we are not going to come up with a better system for providing healthcare unless there is compromise. It cannot be one or the other, because, as Congressman Gerlach noted, the current enactment did not stand the test of times in terms of bi-partisanship. Only compromise will produce a bill that will.