AHIMA17: Former congressional leaders think ACA fixes, not repeal, now more likely

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 - AHIMA debate

Former House Speaker Newt Gingrich and former U.S. Sen. Barbara Boxer, D-California, were brought to the American Health Information Management Association (AHIMA) conference in Los Angeles to have a political-style debate on healthcare policy, but ended up agreeing on where short-term efforts may go now that repeal of the Affordable Care Act (ACA) failed to pass.

The two didn’t agree on the exact status of the ACA. Gingrich described it as “not working,” with premiums rising to become unaffordable for individual market customers. Boxer did acknowledge problems with “parts” of the ACA, which she had voted for as a senator, like rising premiums on the ACA exchanges.

She maintained the law as a whole has been beneficial, citing gains in insurance coverage, the banning of lifetime or annual limits by insurers and the decline in medical-related bankruptcies. What could help bring down costs, she said, was adopting policies in areas the ACA didn’t touch.

“Medicare still can’t negotiate with the drug companies,” Boxer said. “If we did that one thing, it would impact the affordability question.”

Boxer also accused the Trump administration’s officials at CMS and HHS of “sabotage” on the ACA, such as continued uncertainty surrounding the cost-sharing reduction payments to insurers and cutting the outreach budget and sign-up time for the upcoming open enrollment period.

Gingrich did agree that ACA repeal won’t happen in the month or so of legislative days left in the year. He blamed much of the failure of repeal-and-replace efforts on the process Republicans took, saying the rushed bills mirrored what the party had long criticized Democrats for doing when they passed the ACA. His prediction was the ACA would be replaced “piece by piece” in states where it’s less popular or perceived as not working.

The healthcare system has broader problems, he said, as he called the current relationships between providers, payers and patients “unsustainable.”

“The person who doing the paying isn’t getting anything of value,” Gingrich said. “The person who is getting the thing of value isn’t paying for it and doesn’t value it and the person who is delivering it knows the person who is paying for it doesn’t trust them and the person they’re taking care of isn’t grateful.”

Despite the heated debates over the ACA ever since its early stages, both Gingrich and Boxer thought there was an opening for a compromise. Gingrich said he had advised the Trump administration not to tackle healthcare reform first, instead going for after other legislative priorities which could garner Democratic support and perhaps bring some bipartisanship to a healthcare bill. Which that opportunity gone, Gingrich said the two leaders of the Senate health committee—Sens. Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington—can work on legislation as they did with the 21st Century Cures Act.

Boxer agreed those talks will be the vehicle for short-term “stabilization” of the ACA markets, with the likeliest trade off being Democrats getting some guarantees on funding for ACA while Republicans get action on state waivers for ACA regulations.

“Everyone comes out of it feeling like did I win or did I lose, but that’s how we have to move forward,” Boxer said.

In the long run, however, Gingrich predicted a sort of reckoning for the healthcare system, which he called “ten times more complicated than national security.” He said many of the same industry groups which were strongly opposed to this year’s repeal-and-replace bills will have to choose how to address growing support among Democrats for increased regulation, such as a single-payer system, or whether they should move closer towards Republican proposals.

“We’re really at a great crossroads,” Gingrich said. “We’re either going to continue sliding towards a centralized, bureaucratic model or we’re going to find a way to break loose and have genuine competitive interests, and the large interests can’t quite decide which they hate more.”