Expansion of Medicaid in the 19 states that have not already done so should be a healthcare priority of the next president and Congress, a panel of healthcare policy experts told a breakfast audience Thursday of the Nashville Health Care Council.
The big question is how to structure the expansions to garner bipartisan support under either an administration of Hillary Clinton or Donald Trump, said Tom Daschle, former U.S. senator and founder of the lobbying firm, The Daschle Group.
Daschle said if the federal government is more flexible in the way it allows states to implement Medicaid expansion, and takes into consideration the budgetary constraints many face, they are likely to see the merits of expansion.
The current way for states to expand Medicaid with some variance from the federal method is through waivers, which panelists said was time-consuming and still did not provide enough flexibility.
“It's important to remember that it took 17 years to implement Medicaid in all states when the program began, so it will take time,” said Daschle. “If we can create flexibility, addressing the specific needs of each state and allowing each state to create its own implementation plan, we will see more expansion.”
Daschle was joined on the panel by former Utah Governor Mike Leavitt and Nancy-Ann DeParle, partner in the private-equity firm Consonance Capital Partners and former director of the White House Office of Health Reform under the Obama administration. The panel was moderated by former U.S. Senator Dr. Bill Frist of the founding family of HCA Holdings in Nashville.
Right now, the mostly “red” or Republican Party-led states balking at an expansion of Medicaid see its expansion as promoting President Barack Obama's signature Affordable Care Act, Leavitt said.
If that perception can be excised under the next administration, and states are given flexibility to expand to what their budgets will allow, Medicaid expansion stands a chance in the 19 states, Leavitt said.
DeParle said patients seek care in emergency rooms and elsewhere in non-expanded states and that's a problem for providers. She said proposals being floated by Trump to fund Medicaid through block grants and other means is contrary to the citizen expectation that their healthcare is an “individual entitlement.'
Leavitt said the presidential election is boiling down to the different philosophies regarding the role of government in healthcare.
The current approach is one that sees the consumer as needing protection from government, with the administration instituting policies that mandate certain coverage and regulate how much providers should be paid for specific illnesses in government-sponsored plans such as Medicare and Medicaid.
The Trump approach is one that relies more on state block grants and personal savings accounts that puts coverage and care choices more in the hands of individual consumers, Leavitt said.
Daschle said traditional fee-for-service is on its way out as consumers with high-deductible plans and Medicare with bundled payments push for care to be administered in the appropriate cost and quality setting.
He lamented that policy changes too often lag technological innovation that needlessly raises the cost of care.
Daschle cited telemedicine as an innovation that could be used much more widely if it was promoted by payers, including for treating patients with depression and behavioral health issues.
DeParle said one area that has had an outsized impact on what have been years of moderated healthcare cost increase is pharmaceuticals.
She said Clinton has made known her intention to tackle that issue if elected.