Obamacare by another name...
Nikhil Bhojwani
Managing Partner @ Recon Strategy | Healthcare Consulting | AI in Health | Visiting professor | Keynote speaker | Alum of Wharton, BCG, St. Stephen's College
Once the new administration repeals Obamacare, what comes after it could share a lot of the underlying logic of the ACA, even as it may be positioned as being very different.
This is because policy makers have the same goals, will face the same market factors, and have to deal with the same trends, as the ACA.
The goals of any healthcare policy in the US (or indeed around the world) are the same as those of Obamacare:
- Better quality care
- Cost-effective care
- Broad access to care
The market factors that policy designers face are the same as those faced by the ACA. These include:
- Entrenched incumbents
- Concentrated providers and payers within geographies
- High market power of drug and device manufacturers
Finally, there is no escaping from the trends that the ACA had to deal with that are, if anything, even more pronounced today. These trends were (mostly) headwinds against the goals mentioned above.
- Increasing consumer demand (including driven by supply attributable to Fee-for-Service incentives)
- High inflation driven both by market power and by new technology
- New delivery models such as retail clinics and telehealth
- Significant insurance gaps including a high rate of uninsured/ underinsured
The bar is high on that alternative and given these underlying commonalities, it would be hard to throw out everything and come up with a solution that works. Many aspects of the ACA including consumer friendly regulations (e.g. guaranteed issue and coverage of adult children under parent plans), delivery system reform (e.g. value based payments), and expansion of coverage under Medicaid (though through block grants and state control) should substantially survive even if they are described in different terms.
Most interesting will be to see how any new dispensation is able to retain these features of the ACA while axing the features that are unpopular (e.g. the individual mandate) but provide the checks and balances necessary to achieve the goals around cost, quality, and access.
More perspectives at the Recon Strategy blog