Cool morning temperatures. Earlier twilight. A few fallen leaves skittering across the sidewalk. The hints of fall are already here in the Upper Midwest.
And so are the hints of a shift in the political winds. The latest Kaiser Family Foundation tracking poll showed most Americans are more concerned about the rising price of drugs than repeal of the Affordable Care Act.
But drug prices are not the only cost issue on peoples' minds. Though 90% of the population is now covered by health insurance thanks to the ACA, 52% of the poll's respondents still see “paying for healthcare and health insurance” as a financial burden.
The number one problem identified by the respondents was their health plans' high deductibles (17%). The number two problem was the cost of their health insurance premiums (14%). Drug costs were third (11%).
The reality is that a growing number of people, whether they receive their health insurance as an employment benefit or purchase a plan on the exchanges, are paying more than ever before for healthcare.
According to the Kaiser Family Foundation, 38% of workers enrolled in employer-sponsored plans for individual coverage in 2013 were in high-deductible plans requiring out-of-pocket payment for the first $1,000 or more of healthcare costs. People who bought high-deductible bronze plans on the exchanges are only now discovering the implications of their choice.
With paychecks stagnant, any new expenses hurt. That's why Republican calls to repeal Obamacare still could resonate next year, not just in the primaries, but in the general election. Affordability matters.
While the ACA has nothing to do with the employer-driven shift to consumer-driven medicine—blame decades of healthcare inflation—the Democrats could be put on the defensive.
The details of ACA replacement plans that some Republicans have already put forward don't address the issue. For instance, previous high-risk pools for high-cost patients with pre-existing conditions, similar to what the GOP candidates propose, have repeatedly failed because they require enormous taxpayer subsidies.
Without the ACA's mandate that everyone obtain coverage, many people who aren't sick would ignore the GOP-proposed premium tax credits that would help with a fraction of the actual cost of buying a health plan. The 50% of the population living in households earning less than $52,000 will make that purchase decision based on their share of the bill.
Selling health insurance across state lines without federal essential-benefits mandates is a prescription for a major expansion of bare-bones catastrophic insurance coverage. Consumers would be dissatisfied with such plans.
Still, the latest Kaiser poll suggests the public has no interest in another debate over the shape of insurance policies. One way to move the discussion forward would be to force candidates from both parties to offer plans to make consumer-driven healthcare work.
What would they do to increase price transparency? Are there new ways the government can foster meaningful competition between health systems and networks beyond wielding outdated antitrust law? Should Medicare's benefit and copay structure be modified to make it easier for seniors to identify what's valuable and what's not in healthcare?
Also, how would the Republicans foster delivery system reform? Half the healthcare reform law they would repeal has created experiments in accountable care and other value-based care models and established pay-for-performance rewards and penalty programs to boost quality.
If the GOP's health reform plans would simply force the delivery system to adapt to shrunken Medicare and Medicaid budgets, the candidates should make that explicit. Providers speak about being on a “journey” toward delivering value-based care. If it's going to be a forced march, they deserve to know.
Meanwhile, the national conversation about healthcare is moving on. Candidates stalking New Hampshire and Iowa are getting an earful about the opioid-abuse epidemic. During dinner at Modern Healthcare's Women Leaders in Healthcare conference last week, I sat next to officials from Kentucky and Tennessee. Substance abuse was the number one topic of conversation. Drug-addicted babies are once again crowding their neonatal intensive-care units.
I still have hope that when it comes to healthcare, the presidential campaign will offer more than another sterile debate over a law that's actually working.
