« September 2015 Issue

What’s on Tap for Congress and the Campaign Trail this Fall

With the Supreme Court decision in King v. Burwell behind us, it’s back to reading the political tea leaves as Congress heads into what will likely be a contentious budget debate. The 2016 presidential election is lurking in the background and new and unexpected issues are drawing bipartisan cooperation. Fortunately, Michael Miller, Community Catalyst’s Director of Strategic Policy, is here to provide a guide to the federal landscape and what to expect in the weeks and months ahead. Be sure to check out Michael’s weekly take on health care news in our Health Policy Hub blog feature, “The Takeaway.”  

What can we expect from Congress on health care issues this fall as they consider the budget?

I expect we will see two main things. One would be some sort of Affordable Care Act (ACA) repeal package that will be positioned as a “down payment on repeal.” It won’t be full repeal. The other would be the attempt to defund Planned Parenthood that is getting more play in the media. The ACA package will likely include the repeal of the employer mandate, individual mandate, Independent Payment Advisory Board (IPAB) and one or more of the tax provisions like the so-called “Cadillac tax” (a tax on high-cost health plans) or the medical device tax, or both. They will be mostly pulling their rhetoric from same songbook.  However, it might not just be Republicans who are putting the ACA front and center, we might see Democrats getting in on the action as well, for different reasons.

The real reason for this maneuvering around ACA repeal is to look for those pieces of the ACA where people think there is a political advantage to going on the record or getting the other party on the record with a vote. This means they won’t do things like try to repeal tax credits or Medicaid expansion, even though they are big budget savers because those are popular with voters and would be unhelpful votes to take. But the individual mandate, the Cadillac tax – these send the message of “the other guys are going to make your health care costs go up by having a tax on your good benefits,” so there is a potential win there. For Democrats, it's about getting opponents of the ACA to vote for things like bringing back some form of pre-existing condition exclusions or lifetime caps on care. None of this is about good policy; it’s about a paper trail for campaign commercials.

We are in the early stages of the 2016 presidential campaign. How do you see the ACA playing a role as the campaign continues?

It’s been really interesting to watch the ACA fall off the table as an issue on the Republican side and to watch the Democrats move to reembrace health care as a policy issue. On the Republican side, they are all on the record as “repeal, repeal, repeal.” But where they get stuck is that while the majority of GOP primary voters support repeal, the majority of the electorate opposes it. From that point of view, the less said about it the better. It will just hurt them in the general election. For Democrats, they are returning to the issue largely because it is bubbling up as a voter concern. They are trying to straddle being against repeal and knowing that a simple defense of the ACA doesn’t always match how voters feel about the health system, in particular their costs.  

Aside from the budget debate, what other health care issues are gaining traction in Washington D.C.?

We are seeing an increased potential for bipartisan cooperation around a few new issues. Even though Democrats and Republicans have differing big-picture visions about the future of Medicare, there is more agreement around the idea that we should get something for the money we are spending. We see a different kind of conversation that is more grounded in data, and is more serious than previous “gotcha” moments. For example, how do we deal with the fact that a high percentage of health care costs come from a relatively small number of high-need and high-cost patients? Let’s look at that and look at the care those folks receive and see if we can do a better job. 

Prescription drugs are moving to the front burner, as well. This is really interesting, and in some ways challenging for both parties. Prescription drug costs and availability are percolating up as interests for Congress in their legislative function and for candidates on the campaign trail. With the drug issue it’s easy for people to agree about the problem – the high cost of prescription drugs – but much harder to see where the common ground is for policy solutions.

As Community Catalyst develops its work on health system transformation, how will that affect our federal policy priorities moving forward?

On health system transformation, I would say that the Congressional wheels grind slowly and we’re still trying to scope out a landscape. Health system transformation is really complicated because there are a lot of different topics and there often isn’t a clear “yes/no,” position – rather it’s a question of degrees. We will need to figure out the avenues where we can actually make progress. We’ve made a lot of progress in thinking about what really matters to patients, consumers and communities in health system transformation. Right now we’re in the stage of figuring how to get those things to happen. Is it weighing in on the regulations around Accountable Care Organizations (ACOs)? Is it influencing new models for how doctors are paid in Medicare? Is it new legislation in Congress about how health outcomes are measured for health systems that treat low-income people? Likely, all of them, and many more to consider as we think about the most promising opportunities to most widely effect change.  

Lucy Dagneau, Associate Director of Communications