Kaiser Permanente, by far the largest integrated delivery network in the U.S., has much at stake if the Affordable Care Act is unraveled under the administration of President-elect Donald Trump. Kaiser CEO Bernard Tyson has been an outspoken advocate for giving all Americans access to affordable and high-quality healthcare. He also was one of many top healthcare leaders who supported Hillary Clinton's bid for the White House. Modern Healthcare Midwest Bureau Chief Bob Herman interviewed Tyson the day after Trump defeated her, signaling a likely end to the ACA. The following is an edited excerpt.
Modern Healthcare: How did you watch the election and the reaction as it unfolded?
Bernard Tyson: At home, like most people glued to the TV. I was trying to absorb what was going on in terms of how it was turning out and then how consistent it was with everything I had heard before. I, like most people, was surprised by the outcome.
MH: What was your reaction when you realized the ACA may be on its way out?
Tyson: I believe in the American system and every American gets one vote to make decisions on behalf of the whole country. People cast their votes last night and the results were the results. I'm a pragmatic person. This is what our country has decided, and with that is the question of the implications of the differences in the points of view of how healthcare should be covered and paid for in this country.
During the campaign, Trump shared views about the ACA and views on what he would do when he was president. He also shared views that people who might not have the money didn't have to suffer unnecessarily. And I'm hoping and I'm hearing that while he may not agree with the current construct called the ACA, he seems to agree that everyone ought to have affordable, high-quality care and access. So my question is, how do I contribute so that we continue down that road to make sure we make healthcare even greater, more affordable and accessible?
MH: Do you think the individual mandate will stay, or do you think we'll go back to the days of medical underwriting?
Tyson: No idea. And what I don't want to do is speculate. I just think it's important that level-headed people work toward the greater outcome, which is people need healthcare in this country and they will need it in the future. I'll be the first to say, and I've said before, it is unaffordable for a lot of people. We still need to solve affordability and access to high-quality care and how we get there. The ACA is one way and it made progress, and as we all admit there are areas to work on.
If for whatever reason the ultimate decision of the new administration is to get rid of the ACA, which Trump has been public about, the question is what goes into its place. I don't know the answer to that, but I'm all-in in supporting the administration once they get on board with helping us figure it out.
MH: What's your take if Trump decides to go along with conservative ideas put forward by House Speaker Paul Ryan like interstate insurance sales, Medicare shifting to premium support and Medicaid block grants?
Tyson: Well, we haven't done the detailed analysis for the different possible options. Any solution put on the table comes with pluses and minuses and trade-offs that we want to think through together to achieve the ultimate outcome.
So if it turns out these are the building blocks for discussion, we would hope to be part of those deliberations to really figure out the positives and the challenges to be clear-eyed, but as a country we haven't gone through it to analyze.
MH: It was clear healthcare leaders supported Hillary Clinton and building on the ACA, and you were part of that support. Are you disappointed Clinton didn't come through and with the disconnect between healthcare leaders and the electorate?
Tyson: I supported Clinton and that's a choice I made at a personal level, and others supported Trump. As a country we have a voting system that allows each person eligible to vote to cast a vote. I support this country and the structure.
The country has decided that Trump will be the next president and I support that. My obligation is to make this country better. My obligation is not to sit on the sidelines and say the person I supported did not win, I'm not going to play ball at a personal level. I support what our country stands for.
At the same time Kaiser Permanente has made clear we have been working with both sides of the aisle throughout the history of the organization with the goal of making healthcare more affordable and available to everyone. That will not change. We will continue to lean in and be a voice to help solve the problems in this country around the high cost of healthcare for the American people.