What’s at stake for hospitals in the 2018 election
An election year usually means little movement in Congress on major policies. That’s especially true for hot-button issues in healthcare, according to Tom Nickels, the American Hospital Association’s executive vice president of government relations, meaning major reforms may have to wait until after the midterm election—or perhaps after the next presidential race.
In his political update at the American College of Healthcare Executives (ACHE) Congress in Chicago, Nickels said healthcare has already been a deciding factor in special elections during President Donald Trump’s time in office. In Pennsylvania’s 18th congressional district, Public Policy Polling found 52 percent of voters in their March election ranked healthcare as either the most important or a very important issue. Support of Republican efforts to repeal the ACA was found to make voters less likely to support Republican candidate Rick Saccone, who ended narrowly losing to Democrat Conor Lamb—even though Trump had won the district by 20 percentage points less than 18 months earlier.
To Nickels, this was one of the signs that a Democratic wave is coming in November, with voters motivated in part by the unsuccessful Republican efforts to repeal the ACA. Republicans will likely keep the Senate, he predicted, but lose their majority in the House, leaving a divided government for the second half of Trump’s first term.
“If that is the case, it’ll have a dramatic impact on repeal-and-replace, the budget, entitlement reform, you name it,” Nickels said.
If Republicans hang onto both houses, Nickels guessed the Graham-Cassidy version of ACA repeal—which would change much of the law’s funding into state-administered block grants—would be revisited after being shelved due to lack of support in the fall of 2017.
Major changes to healthcare policy will then likely have to wait until after the next presidential election. Nickels said Democrats may still be motivated by threats to the ACA, but he also guessed the party could go “too far left” as members drift toward supporting more government control of the healthcare system.
The AHA and many other healthcare groups oppose these efforts, like single-payer healthcare or expanding Medicare eligibility to people between the ages of 55 and 64. He drew a laugh from the ACHE crowd by sarcastically saying, “What a great idea. Let’s take a program that underfunds everything and apply it to everybody.”
Those same industry groups, the AHA included, were also united in opposition to the ACA repeal efforts—and legislation still passed the House and came within one vote of making it through the Senate. When asked by HealthExec if a similar scenario could play out with Democratic lawmakers ignoring the industry’s opinions when it came to single-payer, Nickels said no, arguing lobbying power wouldn’t be the only force working against such a radical change to the U.S. system—pointing out Democrats had 60 votes in the Senate in 2010 and couldn’t attach a public option to the ACA.
Any shift toward more government control of healthcare, he said, would have to be based on what voters say in the next presidential election, though nothing would change AHA’s position.
“That other election has to embrace that issue,” Nickels said. “It has to be somebody won campaigning on single-payer, Medicare-for-all, etc. I know we would be against it. We beat it the last time. I think we would beat it again.”
Nickels did offer a mild warning to the healthcare leaders at ACHE. The current healthcare system is “not affordable for many, many people,” he said, and he expects both parties will want to tackle that issue—with very different proposals—in the coming years.
“If we don’t help them find solutions, they’re going to come up with solutions we’re not going to want,” Nickels said.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.