Page 14 - SFHN Dec 2020

Cover Story: “So Now What?”- Healthcare Organizations Wonder

What’s Next Under a New President and a Divided Government

Continued from previous page
COVID-19 Response: dered an angry response from the hospi- Potential Healthcare Policies in a New Administration
President-elect Biden has made it clear tal industry.
that he thinks that the Trump adminis- However, Mr. Biden is likely to contin- Policy Proposal Likelihood of Effect on
tration has failed the American people ue to seek greater access to care in other Happening Providers
and that Mr. Trump’s “leave it to the ways. He will almost assuredly seek to
states” approach to dissemination of expand the role of the Affordable Care
PPE, testing of individuals, and distribu- Act by increasing the availability and the COVIDͲ19 Response
tion of vaccines has not worked. He pro- magnitude of federal subsidies for indi- Enhanced federal role in response
poses a much more active and involved viduals purchasing insurance on the Increased Testing Capacity
role for the federal government in the Exchanges. And he will likely look for Allow FDA to make independent decisions N
pandemic response. He has already ways to make Medicaid more attractive Rejoin World Health Organization N
assembled his transition team of public to states as well. Address racial, ethnic disparities
health and healthcare industry advisors During the pandemic, the Trump
and he has begun to address racial and Administration acknowledged that the Enhance Access to Care
ethnic disparities in testing and treat- economic consequences of the pandemic Public Option
ment. He also believes a well-coordinat- would cause the Medicaid rolls to swell,
ed worldwide response to COVID would and it therefore temporarily increased Lower Medicare eligibility age
be helpful, and he is therefore proposing the Federal Medical Assistance More subsidies for ACA
to rejoin the World Health Organization Percentage (FMAP) match for Medicaid Increase federal match for Medicaid
and to ramp up collaborative efforts in services to ease the strain to state budg- Stop efforts to make Medicaid more restrictive
the Pan American Health Organization. ets. Mr. Biden is likely to make these
increases permanent and to stymie any Control Rising Healthcare Costs
Enhanced Access to Care: efforts to make Medicaid more restrictive Allow CMS to negotiate Medicare drug prices
Mr. Biden has decried the Trump by implementing block grants or work Index drug pricing to international rates
Administration’s repeated attempts to requirements. These enhanced “access Limit outͲofͲpocket costs for Medicare recipients
repeal the Affordable Care Act and has to care” efforts should be a net positive Eliminate Surprise Billing
developed his own rallying call for a for providers as they see a greater pre- Improve price transparency
“public option” alternative to private ponderance of insured patients and fewer
health insurance that members of the uninsured patients. ProviderͲspecific Issues
general public could buy into. This lofty Telehealth Reimbursement Parity
policy proposal will almost certainly not Control Rising Healthcare Costs:
have any legs in a Republican Senate. Expanding access to care will come at Maintain 340b drug discounts for safety net providers
Likewise, Biden’s proposal to expand a cost to the federal budget, and Mr. Slow mergers & acquisitions
access to care for older Americans by Biden is therefore likely to try to pay for Improve Interoperability
lowering the eligibility age for Medicare part of this increased federal expense by
from 65 to 60 will probably meet legisla- finding ways to limit payments to drug Legend: Probable Possible Not Likely
tive resistance and has already engen- companies, physicians, hospitals, and
Positive Effect Negative Effect N Negligible effect

other organizations receiving federal dol- power of their own health information,
lars through Medicare and Medicaid. and that will require providers to ramp
Most efforts on cost control signal a net up their Electronic Health Record inter-
negative for providers. operability efforts.
Although President-elect Biden cam- One issue that may easily get caught in
paigned on a platform to allow Medicare the political crossfire between the House
to negotiate or set drug prices, the push- of Representatives and the Senate is the
back from the pharmaceutical industry ability for safety net institutions to access
will likely prevent that from happening. low-cost 340b drugs and benefit by
Likewise, Congress will probably contin- receiving a reimbursement rate much
ue to struggle to find a solution for “sur- higher than the drug cost. One issue he
prise billing” by out-of-network will likely not shy away from, however, is
providers. However, there seems to be the growing concern among consumers
bipartisan support for providing some about large healthcare systems exercising
consumer relief on drug pricing by set- undue market power and actually
ting drug prices at no greater than the increasing prices after a merger or con-
international pricing average. solidation. That may not bode well for
It is likely that the new Administration providers who have suffered financial
will try to limit the total out-of-pocket losses during the pandemic and are
expenses for Medicare enrollees. In yet therefore looking for a larger partner
another nod to consumers, the Biden with deep pockets to stay afloat.
administration is likely to continue to None of these issues are cut and dried,
support both insurer and provider price and all of them are complex. We know
transparency initiatives to help con- that there will be an interest by the new
sumers “shop” for healthcare services. President to quell the pandemic, increase
access, and empower the consumer. Yet
Provider-specific Issues: we also know that there will be a coun-
Mr. Biden will likely continue the slow tervailing interest in the Senate to curb
march to value-based care, but his big government spending, lower taxes,
approach will probably be more con- and allow market forces to prevail. The
sumer-centric than provider-focused. reality is that none of us have a crystal
For example, he will likely push for per- ball. All we know is that it will be an
manent parity of telehealth reimburse- interesting four years.
ment because it furthers his goals of
improved access for consumers. He will Calvin Glidewell is President and CEO of
also want to arm consumers with the inspirEx Healthcare Strategies.

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14 December 2020 southfloridahospitalnews.com South Florida Hospital News