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Healthcare after the mid-term elections [PODCAST]

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The Hospital Finance Podcast

In this episode, a roundtable of guests joins us to discuss the issue of healthcare in the recent mid-term elections and what lies ahead for this important issue in the 2020 elections.

Learn how to listen to The Hospital Finance Podcast on your mobile device.

Highlights of this episode include:

  • Guests include: Fred Turner, Chief of Staff for Sen. Bob Menendez (D-NJ), Jon Besler, CEO of BESLER, and Molly McDonnell and Mike Merola of Winning Strategies Washington.
  • Why healthcare was an important voting issue during the recent mid-term elections
  • Where a divided Congress can find common ground on healthcare
  • Potential Medicaid expansion changes with the election of new state Governors
  • Why Medicare-for-all may be a hot issue for the 2020 elections
  • And more…

Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast.

Today, we’re going to be talking about healthcare post midterm elections and to walk us through where we might be going in the months ahead. I’m joined by Fred Turner who is Chief of Staff for Senator Bob Menendez here in New Jersey; also Jon Besler who is the CEO of BESLER; Molly McDonnell of Winning Strategies Washington; and Mike Merola of Winning Strategies Washington.

Everyone, welcome to the podcast!

Group: Thank you. Good to be here. Thank you, Mike.

Mike Passanante: So, we were chatting just before the podcast began and reconciling what happened in this midterm. And one of the things that has been noted I think in the media a lot since the midterm is the exit polling. And one of the statistics that we’ve been talking about is the fact that, for voters, it seems about 41% of them noted that healthcare was still their top issue.

I found it fascinating. With all the passions and issues that are out there in the country, that issue has not been forgotten. It’s still on the voters’ minds. And it was in the voters’ minds as they went into the polling booths this past Tuesday.

So Fred, let me open it up with you. Where do you think we go from here? It’s obviously in everyone’s minds with a divided government going forward. What are we looking for in terms of healthcare?

Fred Turner: Well, let me just say to your first point, certainly, in the polling that Senator Menendez’ campaign did over the past 16 months, we certainly knew in New Jersey that healthcare was very much at the top of people’s minds. Millions of people who do not have access to health insurance prior to the Affordable Care Act coming into existence had that access.

Close to a million New Jerseyans have some type of pre-existing condition that they wanted to make sure, moving forward, their health insurance would cover.

And so, we certainly knew with the Trump administration and the leadership and Congress trying to get rid of the Affordable Care Act that people in New Jersey foursquare against that. We knew that was something we wanted to talk about.

Senator Menendez was one of the original authors of the Affordable Care Act. He knows the benefits that it’s brought to the nine million people that he’s privileged to represent here. And so that was something that we were absolutely going to talk about.

And as it happens, this is obviously something we didn’t plan on. We had the benefit in some respects of running against a pharmaceutical executive who we thought we had an opportunity to tell a story about the high cost of prescription drug prices. And Mr. Hugin had to tell his story about the high price of prescription drug cost.

So, it’s certainly something I think next Congress is going to tackle. It’s certainly an important issue in this race.

Mike Passanante: And Molly, this was obviously an issue that was on the minds of the Trump administration when they first came into office. It’s something they tried to tackle but didn’t get over the finish line with the changes that they wanted to see.

Now, with the divided congress, what do you think might be on the agenda for them? Where do you think they might be looking for a common ground or other changes perhaps on the regulatory stance?

Molly McDonnell: Yeah! So, I think that drug pricing is going to be high on the agenda. In the past, it’s been something that has been more of a Democratic issue. But I think President Trump, it’s something that he’s talked about a lot and put a lot of Republicans in a somewhat difficult situation having to face their constituents and face the president over the high prices of prescription drugs.

And so, I think there are definitely areas that Republicans and Democrats would be able to come together on. The administration has obviously continued to push forward with regulatory efforts to that effect. But I know that that is something that the Democrats that are coming into power have said that that would be top of their list.

Mike Passanante: So, common ground on drug pricing perhaps going forward. That could be an issue that they could look for common ground and tackle that.

Molly: Yeah, I think so.

Mike Passanante: It was obviously noted that about seven governorships I think flipped to the Democratic side this past Tuesday. One of the things that I wanted to put out particularly to Jon and Mike in particular, we talk about things like Medicaid expansion and those states—some of them—that was a road that they were not going to go down. Do you see that changing in the coming months?

Jon: I absolutely think it will. Whether you call it the Affordable Care Act or ObamaCare or something other than that, I think the basic tenets of the healthcare system that we have now are overwhelmingly popular and overwhelmingly positive. I think Medicaid expansion is a key example of that.

If you look some of the other polling that’s been done, when people now have access to healthcare that otherwise didn’t, they like that. That’s a positive thing in their lives.

And so, I think as we look across the national landscape in the states that did expand Medicaid and did provide additional access to other folks that otherwise wouldn’t, the other states are looking at them and saying, “Well, why didn’t we do that? Why can’t we do that? And if we have control over it, well, let’s do something about it.”

So, I think the expansion is something that now with the blue wave or the blue ripple—again, whatever you want to call it—across the country, I think we will start seeing some very smart and fundamental changes from the states that did not expand Medicaid, they will now take a hard look at it and be forced to because their constituents now want that. They look at other folks across the country and say “Why not?”

Mike Merola: The only thing I’ll add to that is that Medicaid censure was on the ballot in three states. And those states overwhelmingly agreed to do that. So I think we’re going to see, if the governors of states are not going to do it, I think you may see people trying to take it into their own hands to make sure it happens more and more.

Mike Passanante: Do we see a Medicare-for-all push coming? Certainly, there were some progressives that won that was sort of I think more left-leaning. In certain cases, that was an issue for them. It’s something that they brought up a lot during the campaign. Is that something that you think we’re going to see a push on for the next two years? Is that more of a 2020 type of a discussion? What does that feel like going forward?

Jon: From my perspective, I would say that that’s a much longer-term strategy and tactic that I don’t think we should give up on as a country. I don’t think there’s a lot of merits to taking a hard look at programs that, again, could provide access and do so in a fiscally responsible way.

When you look at the Medicare program, it’s the most efficient payer across our healthcare delivery system. About 96% of funding goes directly into patient care with a very low administrative cost associated with that.

So, I do think that if we have the right people in the room really talking about the basics of what Medicare provides, as well as what we can roll out fundamentally across the country, I don’t think it’s a conversation that we should shelf.

That being said, I do think that it’s a longer-term conversation. I don’t know if we are fundamentally there as a country to really embrace something like that because I think you’ll see both sides of the aisle maybe pushing towards extremism in either way. And once you start clouding the conversation with the extreme ends of the argument, I think you very unfortunately tactfully miss what really can happen in the middle which is negotiating and coming up with a responsible policy that works for everyone.

Molly: I think, to that end, I think we’re going to be hearing a lot more about Medicare-for-all over the next two years. And I would imagine that it will come to a head in some ways in 2020. And I think Democrats ultimately need to decide what Medicare-for-all means.

We’ve seen even throughout the midterms that different candidates have different definitions of what the actual nuts and bolts would be of the policy. And so I think it’s going to be a little bit of a come to Jesus over the next two years. And whoever’s at the top of the ticket for the Democrats, they’re going to have to come to an agreement on what that means, how stronger they’re going to push for it, and whether it’s feasible.

Jon: And let me just add. You reminded of another point that I wanted to address. I think we need to define what Medicare-for-all really means as a country. You could ask two people, it could mean two very different things—let alone either side of the aisle.

And so, as we’ve seen certainly in our business with Medicare Advantage Plans, really having what I would call a guise of Medicare, it really isn’t.

And so, if we’re talking about Medicare-for-all, and we’re saying, “Well, Medicare-for-all really takes the form of ‘let’s just push it off to the Medicare Advantage Plans that are supposed to be a proxy for what CMS and Medicare does,’” it does not play out that way in a very tactical level, specifically for the hospitals, for the providers, and also for the patients.

And so, when we talk about Medicare-for-all, I think we should also be very careful to not push us into Medicare-Advantage-for-all because it is two very different animals that we need to be thoughtful and considerate about.

Fred: I don’t disagree with any of that. I would simply say that, as Jon says, he’s not certain that the country is really in agreement for Medicare-for-all. I would take that a step further and I would say they’re certainly not, at least if they’re reflected by their representatives in Congress.

I think for Democrats, what we believe is the more Americans that have access to quality healthcare and quality insurance, the better off this country is. And we’ve had problems delivering quality healthcare to millions of Americans for years and years. So, whether that shape is a Medicare-for-all or something different, we can discuss that.

But certainly, I can imagine that something will come out of the House of Representatives within the next two years from the Democratic majority that would be acceptable to what appears to be an even more conservative majority in the US Senate at this point.

So, I do suspect this is going to be a topic of debate in 2020 for our presidential race and when control of Congress comes up yet again.

Mike Passanante: Just one more area I wanted to touch on. One of the staples of the Trump administration to this point has been deregulation and looking to reduce the number of regulations that we have.

We’ve certainly seen from CMS they’ve backed off on things like some of the mandatory bundled payment programs and other things that affect hospitals across the country.

Do we see any sort of a change in the velocity of that deregulation now that we have sort of a mixed legislature? Does it feel like there’s going to be additional oversight or less aggressive deregulation now that we have, again, a mixed Congress?

Molly: I think there will most certainly be additional oversight. That is probably number one on the agenda for House Democrats.

As to the velocity of the deregulation initiatives, I don’t particularly see them slowing down. I think while there may be more oversight, if the President feels like he’s hitting a wall with a Democratic house, I think he will waste no time in using administrative channels to try to accomplish what he wants to accomplish. And so, if he feels backed into a corner, then I think we’ll see even more coming out of the administration than we have over the past two years.

Mike Passanante: Would everybody agree with that? It seems like…

Molly: Really, that was a great answer.

Fred: I completely agree with that. I think we’re going to see a lot more oversight on the part of House Democrats over the next two years. It’s unlikely for the President to get public law in the way he might want it out of the regulatory agencies. So, the tool to go around Congress certainly is through the regulatory state. And it is exceptionally difficult for Congress to, by law, repeal a regulation. It’s been done, but it takes a majority vote by the House and the Senate. And ultimately, it’s something that the president would veto, and then Congress would have to override that veto in order to strip away a regulation. That is not something that’s going to happen in the next two years.

Mike Passanante: Very good. Well, certainly, healthcare is still a front burner issue. We’ve seen that through the election. It’s something that we’re still grappling with as a country. And I certainly appreciate everyone’s viewpoint on that on today’s podcast. So thank you for joining us.

Group: Thank you. Thanks Mike.

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