The failure of the ACA repeal and replacement bill on March 24 creates a compelling opportunity, if there ever was one. Politically, Trump could still have a win if:
- Bipartisan work can begin to make repairs to the ACA that achieve improved access and affordability;
- Healthcare professionals can be involved in crafting of key revisions from the provider and payer sides to achieve a bill more likely to make improvements; and
- A new effort includes soliciting and incorporating feedback from states and constituents about their healthcare access and affordability experience and current requirements;
Signaling an effort to move in this direction will help stabilize the market now and for 2018. Spending the time it takes to do this work well is another important commitment that could be made and would inspire confidence in the market. If the above path is at all feasible, it is possible that the next phase of improvements in healthcare could be a reality - something that affects every single US citizen.
Except our legislators. A new requirement of the law that would likely be quite popular with most US citizens, including Trump's base supporters, is this:
Legislators will be on health plans that reflect the law of the land. They should experience the results of the laws they pass. Their current exemption keeps them removed from the consequences of their work. Aligning their work with personal experience of the results would inspire credibility at a time when that is greatly needed.
We should all continue to have a sense of urgency to press forward with changes in healthcare delivery that are more cost effective, provide higher value and better outcomes and are more patient centered. We can expect some trends to remain:
- Costs will increase, although less so now with stabilization in the market and, especially, continued coverage for many that were otherwise at risk for being uninsured;
- Aging of the population will continue to drive increased healthcare utilization;
- Consumer behavior will continue to increase as people want their healthcare to be like other things that they purchase, They will want care to be something they can shop for that has demonstrably high value. They will expect the health system to be responsive on their terms (access, communication by email/text/video, easy to navigate, bills that are comprehensive and easy to understand).
- Health system reputations will matter more than ever because of the above three trends.
We will need to press forward with a sense of urgency to create the health system that can thrive in the environment that is already happening around us. We know what we need to do. Let's do it.