Medicare for all?
"We’re going to have insurance for everybody,” President-elect Donald Trump told the Washington Post in an interview over the weekend. "I don’t want single-payer. What I do want is to be able to take care of people.” So while we hear of Affordable Care Act (ACA, sometimes called Obamacare) repeal during the first 100 days of the administration, it sounds as if new programs must be quickly in the works to meet his mandate. “ The Congress can’t get cold feet because the people will not let that happen,” Trump continued, giving further emphasis to his push (and probably tweets) behind this initiative.
Additionally, we hear Mick Mulvany, Trump’s nominee to direct the OMB, say “We have to end Medicare as we know it.” We see mounting evidence from the new administration that Medicare is in for continuing transformation.
So with those mandates, were are we headed?
A major priority is stemming the increasing cost of the Medicare program. So if we are not reducing the number of covered Americans, we will place focus on health savings accounts (HSAs), lower out-of-pocket costs for consumers, and value-based care. Various plans put forth by prominent Republicans, such as House Speaker Paul Ryan and the nominee to lead HHS, US Representative Tom Price, focus on slowing down spending. Both parties strongly supported the Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015. MACRA creates a framework and incentive to healthcare providers for moving away from fee-for-service. The reform / repeal of the ACA will not directly impact the implementation of this program, it was launched under a separate legislative initiative and stands with Republican support. This program would need to reformed in its own right, and to date, we have not heard that mentioned.
The drive to value-based care is going to continue. There has been bipartisan support for the agenda in Washington through the MACRA proposal and implementation. Payers as a whole are adopting the value model, and all agree—payers, providers, and consumers—that a common set of metrics across all payers is solely needed. Medicare is one of the largest payers, whether public or moved to a more private model longer term.
The timeframe for the repeal / reform implementation of the ACA is still not determined, as we learn more, we will share it here.