Setting The Stage For Healthcare Change In 2018

On Forbes, my selections for top healthcare stories of 2017 reflect a year filled with ups and downs, controversy and intrigue. New mergers bloomed whereas others wilted away. All year, Congress swung back and forth on Obamacare repeal. And the #metoo movement brought about new and important discussions on the consequences of sexual harassment and assault.

It’s too soon to say how history will look back on the past year, but I believe American healthcare finished in a stronger place than it started. Let’s take a closer look at how 2017 set the stage for serious and significant changes in 2018.

The Healthcare Politics Of 2017

January began with what many feared would be the imminent repeal of the Affordable Care Act (ACA). Practically since the law’s passage in 2010, the GOP has campaigned on a platform to undo President Obama’s signature legislation.

The opening salvo came this May when the House of Representatives narrowly passed The American Health Care Act (AHCA) of 2017, despite estimates that 23 million Americans would lose their health insurance.

In a powerful demonstration of healthcare’s national importance, American voters flooded the phone lines and turned up at Town Hall meetings throughout the summer, urging GOP Senators to preserve Medicaid expansion, access to coverage and vital preventive health services.

As the debate moved to the Senate floor in June, President Trump ratcheted up demands for a bill that would fully repeal and replace Obamacare.

However, the Senate’s Better Care Reconciliation Act (BCRA) of 2017, was postponed for failing to generate enough support. The Senate then posted the Obamacare Repeal Reconciliation Act (ORRA) of 2017, a plan that would repeal (but not replace) parts of the ACA.

Support for both bills remained uncertain until Sen. John McCain, who had been hospitalized with a brain tumor in July, returned to the Senate floor to cast the final and deciding thumbs-down vote.

President Trump, undeterred by the legislative failures, issued an executive order on October 12 designed to erode the coverage provisions of the ACA. Policy experts noted the order would drive younger, healthier patients away from Obamacare, resulting in significantly higher premiums for sicker people. A day later, the president announced he would end the Cost Sharing Reduction (CSR) payments to insurance companies, a move that would further destabilize the health insurance exchanges.

Months of turmoil surrounding healthcare policy set up a December to remember. On Saturday, Dec. 1, the Senate voted to rescind the “Individual Mandate,” which requires nearly everyone to purchase health insurance or pay a penalty. The bill is part part of the GOP-backed tax plan, which garnered signatures from the conference committee on Friday. Spurred on by the special election of Doug Jones, the first Democratic Senator elected in Alabama since 1992, both the House and Senate are hurrying to put a final bill on President Trump’s desk before the end of the year.

Voters Eager For Healthcare Change  

Largely lost in the 2017 healthcare debate were two significant developments occurring in November. Voters in the Maine state elections overwhelmingly elected to expand Medicaid, turning sharply away from the direction of the Republican-controlled Congress. And in Virginia, not only did a Democrat defeat a Republican for Governor, reversing the usual political calculus, exit polls also showed healthcare to be the biggest issue on the minds of voters in the Commonwealth.

In 2018, healthcare will have no shortage of competition when it comes to headline-grabbing news. There will be other major legislative actions, the ongoing Russian probe and the threat of further diplomatic breakdowns with North Korea.

However, Americans are growing increasingly anxious and unhappy with the state of healthcare. Soaring out-of-pocket costs, excessive drug pricing, and the widespread risk of losing coverage are themes likely bubble to the surface next year. And they will no doubt become significant factors in the 2018 mid-term elections.

It is too early to speculate on whether these healthcare concerns are enough to reverse the GOP’s control of Congress, but candidates who favor cutting healthcare payments for seniors, slashing benefits for Medicaid enrollees or destabilizing the insurance exchanges may face the wrath of voters. It’s one thing to vote for greater choice in healthcare by rescinding the individual mandate. It’s another thing entirely to strip millions of Americans of the healthcare they’ve come to rely on.

NEW POLL: Share Your Thoughts

Last month, I asked readers to grade the American healthcare system based on the criteria of cost, quality, access and technology. The results were even worse than I would have predicted. I want to thank the 100+ people who voted. Here are the results:

This month, I welcome your input on another important healthcare topic:

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Once again, I will let you know the results of the poll in the January issue of “Monthly Musings on American Healthcare.” If you aren’t currently on the distribution list but wish to receive future issues, please send me an email or click the envelope icon at the bottom of your screen.

I appreciate all the readers who wrote me with their feedback and insights last month. I hope 2018 is a time of improved health, happiness and peace for all. Happy New Year.

Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD.