Much as if she were in a Jane Austen novel, the Lady Healthcare, in her day, was quite the bon vivant, with her movements a much-discussed topic leading up to the 2008 election. Her child, the Affordable Care Act, was equally on the minds of those in society leading up to the mid-term elections in 2010, to the point where she was repeatedly threatened with murder through 2012.
But while the ACA, still alive and thriving, has perhaps not been received with pleasure into many long-term care circles, there’s one thing that is clear: Both she and her mother are of little interest today. Their popularity has waned, giving way to consternation over the economy, jobs, foreign policy, immigration and, of course, whether the GOP is going to embrace Donald Trump.
That’s based on an analysis from a February report from the Kaiser Family Foundation, which found Republicans, Democrats and Independents all ranking the economy/jobs to be their greatest concern. In 2007, Iraq was at the top of the list, with healthcare second at 30%, then followed by the economy and immigration. To be fair, once the recession hit, the economy moved up the ladder. But there’s no way around it: Today, healthcare is the greatest topic of concern to 8% of Americans, making it low on the list for Republicans, Democrats and Independents alike.
Of course, long-term care professionals still have vested interest in the less discussed parts of the ACA, such as whether bundled payments will provide any benefits, how much pressure will remain to reduce readmissions, and whether programs to curb the money spent on dual eligibles help or hurt. In evaluating the GOP field, as many in long-term care are doing, it’s worth reviewing the plans and statements of the candidates, especially given the release on Wednesday of Donald Trump’s plan. (Given that Hillary Clinton is the likely Democratic nominee and will defend the ACA, I wanted to dive into the GOP positions. If you would like to read the full Hillary Clinton plan, click here, but the most important parts of it for LTC relate to expansion of Medicaid and hiring navigators to increase access, lowering prescription drug costs, and tax credits for health insurance.)
Trump, the GOP front-runner, has moved beyond saying he’d kill the ACA and create “something great.” Part of his new plan is for Medicaid to move into block grants, Healthcare Savings Accounts to pay pay for out-of-pocket expenses, and lower barriers for cheaper imported pharmaceuticals. It’s unclear whether other countries would be inclined to send us their medications or work with us at all, given that Trump has called Mexican immigrants rapists and said he’d build an $8 billion wall to keep them out.
Ted Cruz has said Obamacare should be repealed and that he’d make reforms to expand Health Savings Accounts and to make healthcare “more personal, portable, and affordable.” He’s described the law as a “job killer,” saying, “Millions of Americans have lost their jobs, have been forced into part-time work, have lost their health insurance, have lost their doctors, have seen their premiums skyrocket.” It’s a nice idea for those who hate the ACA, but it’s untrue based on any study of data. Cruz also pointedly declined to talk in a recent debate about, pre-Obamacare, how many people couldn’t get health insurance because of pre-existing conditions. That’s a part of the ACA almost universally appreciated.
Marco Rubio also has pledged to repeal the ACA and make a better plan. These goals include “reducing healthcare costs” and making Medicaid into block grants for states, as well as giving Americans tax credits to purchase insurance. He wants to defend Medicare, but also to place it “on a pathway to fiscal sustainability by promoting market competition” so that the program can exist for generations to come. That’s a great idea, but one I’m not sure would mean anything tangibly good for providers, or even what it would mean in reality. What’s more clear is Medicaid block grants for states and “reducing healthcare costs” are not good news for anyone dependent on federal government reimbursements. The former would likely mean states can slash LTC reimbursements and the latter likely would mean more scrutiny of Medicare payments.
All of this is perhaps moot. What the GOP candidates, even Cruz, likely recognize is what the Kaiser report ultimately found: About half of Americans say they’re tired of debating the ACA, although 58% of Republicans would like the debate to continue.
It would be unfair to assume long-term care providers vote solely based on their professional interests, anymore than we would assume veterans, factory workers or clergymen do so. But we can assume providers care more than the average American, and take the time to evaluate candidates’ position with the benefit of their expertise.
The Lady Healthcare might no longer be the top-sought guest at a dinner party, but long-term care will always make sure she receives an invitation.
Elizabeth Leis Newman is Senior Editor at McKnight’s. Follow her @TigerELN.
