Still, the CEOs have a hard time imagining either the courts or federal elected officials erasing the most popular provisions of the law, such as expanding Medicaid to low-income adults. Most predicted that if the courts topple the ACA, Congress will reenact it with slight changes to pass constitutional muster.
“If the ACA is struck down without a plan to replace it, we’re in deep trouble in this country,” said Dr. Gary Kaplan, CEO of Virginia Mason Health System. “All those provisions for coverage, pre-existing condition protections, and keeping children on their parents’ health plan have become norms. We have to be prepared to reenact legislation.”
CEOs interviewed for this article had different views of Democratic proposals to establish cheaper public-option health plans to compete with private insurers, which some experts consider a more politically viable approach than Medicare for All.
Peter Fine, CEO of Banner Health, warned that public-option plans likely would underpay providers and disrupt the healthcare system. “We have to make big investments on a long-term horizon,” he said. “When we see a significant level of disruption, does that make us nervous? You bet it does.”
In contrast, Kaplan sees some form of a public-option plan that pays reasonable rates and moves the U.S. toward universal coverage as desirable. In Washington state, where his system operates, public-option plans administered by private insurers and paying hospitals about 160% of Medicare rates are slated to hit the market in 2021, under a state law passed this year.
Still, he cautions that the public-option plans have to pay more than Medicare, and that rates need to be set through a collaborative effort between government, health plans and providers.
“There are huge disparities in commercial rates and there could be some advantages if those payments are leveled out, particularly for those who don’t have pricing power in the market,” he said.