Dallas Morning News
November 10, 2016
Written by Sabriya Rice, Business of Healthcare Reporter
Industry groups in Texas are trying to brace for the impact of a potential Obamacare repeal, but say they have few details to go on.
A "full repeal" of the Affordable Care Act has been a cornerstone in the campaign of now president-elect Donald Trump, who has said he may ask Congress to do so within his first 100 days of office.
Urgency to ditch the health care law was reiterated Wednesday by GOP constituents.
It's “high on our agenda," Senate Majority Leader Mitch McConnell, R-Ky., told reporters. “I would be shocked if we didn't move forward and keep our commitment to the American people."
However, like many across the nation, providers are seeking more details about the nuts and bolts.
“There is considerable uncertainty about what the future of health care looks like,” said Ted Shaw, president and CEO of the Texas Hospital Association.
Trump needs to quickly “put some meat on the bones,” added Joel Allison, president and CEO of Baylor Scott and White Health.
Still, the need for change has been evident, especially given the tumultuous year for both providers and consumers. Texas, which has the highest number of people without health insurance in the country, remained one of a handful of states to not expand Medicaid.
Insurance companies cited major financial losses and reduced their options for individual marketplace plans in Texas or exited altogether. Meanwhile, consumers are facing fewer affordable health insurance options amid soaring premiums, co-pays and other out-of-pocket costs.
“Health care has to transform, no matter who’s in the White House,” said W. Steve Love, president and CEO of the Dallas-Fort Worth Hospital Council. But with early projections pointing to democratic nominee, Hillary Clinton, emphasis had been on improving the health care reform law, not repealing.
A repeal that does not include a replacement plan, which includes the ACA provisions that gained widespread support and reduced the number of uninsured, could be problematic, leaders say.
For example, the elimination of pre-existing condition clauses, the focus on prevention, and allowing parents to keep their children on their health insurance policy until age 26 were generally seen as positive.
The law also provided incentives for providers, that supported price transparency, innovation and encouraged them to move away from the fee-for-service structure that rewarded volume instead of value.
"I wouldn't expect that to stop," said Trevor Fetter, chairman and CEO of Tenet Healthcare. "But we've also been pursuing those things because that is the direction that health care is going in, and not just because of the Affordable Care Act."
Trump has said he will work with Congress to roll out a series of reforms to broaden health care access, make it affordable and improve the quality of the care.
House Republicans, led by Speaker Paul Ryan, unveiled a plan earlier this year to replace the law.
A positive is that there’s now an opportunity to go beyond just support or dislike of Obamacare, Shaw said. “Instead, we must fully invest ourselves in what it means to be healthy, what it means to provide health care, and how we want to pay for it.”
Any plan to change the law would also be subject to the legislative process, which requires support of both the House and the Senate.
“So, there’s going to be a lot of dialogue,” Allison said.
But even without a lengthy repeal, executive power could immediately “bring Obamacare to its knees,” warns Seth Chandler, a professor at the University of Houston Law Center.
“Trump has a big stick to wield to get his way with respect to health care,” he said. “And his advisers are going to make him aware of the stick. I’d be surprised if he doesn’t use it in some way.”
In an opinion piece posted Wednesday on Forbes.com, for example, Chandler pointed to “cost-sharing reductions,” or payments given to insurers to help keep deductibles and co-payments low for marketplace plans.
If Trump decides to withhold that money, insurers could start to drop silver plans sold during the 2017 benefit year.