It’s been over a week since election day, and final counts (and, in some cases, recounts) are still underway. But the broad outlines have come into view: the Senate will remain under Republican control, the Democrats have gained a clear majority in the House, and seven states have flipped from having Republican governors to Democratic ones. And voters made it overwhelmingly clear that health care was a major driver of their decisions in the voting booth. While it’s still early, we’ve been thinking about what the future might hold for person-centered care, especially for people with complex health and social needs. Here are four things advocates for person-centered care innovation should watch for:
- The end of “repeal and replace:” We sincerely hope the days of “now it’s dead, now it’s not” efforts to repeal and replace the Affordable Care Act or severely cut Medicaid coverage through Congressional actions are a thing of the past. Although we shouldn’t completely let our guard down, for better and worse, a divided Congress means it will be challenging to get major legislation passed over the next two years. There are a few areas where there seems to be some bipartisan interest, including controlling prescription drug prices, supporting substance use disorder prevention and treatment, and advancing value-based payment initiatives. We’ll be keeping a close watch on any proposals that might impact access or care for people with complex health and social needs.
- A mixed-bag of increased administrative activity: A gridlocked Congress means that most federal action will happen through regulation – and the Administration is not wasting any time. The votes were barely tallied before HHS issued rules that could limit women’s access to contraceptive coverage, published a major regulation on Medicaid managed care, and announced the return of mandatory bundled payment models. We’re keeping an especially close eye on actions that further erode the Medicaid safety net. The Administration has supported the adoption of policies such as work requirements and lock-out periods that have resulted in many low-income people losing their health coverage. In addition, the Office of Management and Budget posted an announcement about a proposed rule hinting at flexibility for states to no longer cover non-emergency medical transportation (NEMT) for Medicaid enrollees. NEMT has not only been shown to be critically important for health, but has also been shown to reduce costs, and we’ve been working with partners to try to preserve and improve this vital service.
- State-level opportunities to expand coverage and improve care: We’ve always been bullish on states, but we believe that over the next two years, states are going to be the major sites of innovation in health care coverage, access and care delivery. With seven governorships changing to Democratic, the shift of party control in a number of state legislatures, and the success of Medicaid expansion initiatives, we expect greater opportunities to expand and improve Medicaid. We‘d love to see more states invest in opportunities to tackle social determinants of health, such as Pennsylvania’s investment in supportive housing for people with complex needs (with kudos to the Pennsylvania Health Access Network!) and North Carolina’s recently approved Medicaid waiver that includes a strong focus on social services.
- Long-term care: While Maine’s ballot measure for universal home care was defeated, the need to address current and future gaps in long-term care financing and service delivery remains ever present. The aging population, shortage of caregivers and the erosion of the private insurance market for long-term care create conditions that may push more states to seek solutions for the growing number of people who need long-term services and supports. We hope to see more states take on this challenge and look forward to the forthcoming report of a National Academy of Social Insurance study panel on this topic, co-chaired by our research director, Marc Cohen.
Finally, in case you missed it, in the middle of election week, the Centers for Medicare and Medicaid Services (CMS) released its final Medicare physician fee schedule for calendar year 2019. The proposed rule included a provision that would greatly reduce the amount that physicians are paid for office visits with people with the most complex needs. We were concerned that this could have seriously compromised care for such individuals. We are relieved that CMS pared back this proposal in the final rule, which also delays implementation of these changes.
What are you hoping for or worried about after this election? Tweet us @CCEHI.