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Understanding the impact of health care reform

by Kimberly Shores
Supreme Court again rejects challenge to ACA
Supreme Court again rejects challenge to ACA

There has been a lot of talk about the various shapes health care reform might take, both from politicians who are tasked with overhauling the nation's system and those inside the industry who would be strongly affected by regulatory changes. While nothing is decided, there are a few things for certain about the process and the potential fallout that all involved need to understand.

For instance, there has been a lot of concern about the impact that moving onto even a mix of public and private insurance - a halfway point between Medicare for All and the current, mostly privatized system - could have on jobs. After all, health care in all its various aspects has been the leading driver of the national employment surge seen over the past several years and shows little sign of slowing down. Moreover, health care accounts for roughly one-fifth of the entire national economy, so any changes would likely have a far-reaching impact.

A look under the hood

Indeed, new analysis from Kaiser Health News shows there would be a major shift in the national health care system if anything resembling Medicare for All were enacted. Altogether, some 2 million people might lose their jobs, at least initially. However, many of those jobs would be for professionals who act as go-betweens for health care providers and drug companies, insurers and so on - those who, according to Dr. Kevin Schulman, a physician-economist at Stanford, "add to cost, not quality" of care. Likewise, sales reps for pharma companies and medical device suppliers would likely also face job losses.

Altogether, about half of those 2 million lost jobs would be suffered by care providers, and the other half by health insurers, KHN noted. But that is only initially. A federal health care system would need to hire a lot of industry professionals to ensure it runs as efficiently as possible, and care providers would have to staff up quickly to adequately care for the tens of millions of Americans who would gain access to low- or no-cost care.

Getting it right

Of course, there is a big difference between the theoretical impact of such an overhaul of the health care and insurance systems and actually implementing them, a shift that would be difficult to enact, to say the least. Broadly speaking, most lawmakers say they want health care reform, but there are so many competing visions for doing so that a single solution passing in the next few years is unlikely, according to Buzzfeed News.

The truth is, experts and lawmakers widely agree that any overarching reforms that might be made would probably happen after the 2020 federal election, in which the entire House of Representatives, one-third of the Senate and the presidency will be up for grabs, the report said. Until then, competing ideologies about the best way to approach reform will likely result in little, if anything, happening at the legislative level.

In the meantime

There are, however, some changes in the offing, as the Trump administration has taken steps to alter some health care rules unilaterally. Health Affairs noted that a recent executive order to give consumers a better idea of what they will pay for care - and thus potentially make more informed decisions - will provide some clarity. More such orders, regarding other health care cost issues, are likely on the way as well.

For now, the issue for consumers is these changes will potentially only give the government broader authority to make changes in the future, and what changes might actually be made are still very much up in the air. No laws or rules around these issues have officially been altered yet, though these specific, relatively small changes may come sooner than 2020.

What people want

This all comes against the backdrop of the aforementioned election, and campaigning is already well underway for both sides. Health care is likely to be one of the biggest issues in elections for just about every federal seat available, if not the single biggest; nearly 90% of respondents to a Kaiser Family Foundation poll say it's "very important" to discuss health insurance on the campaign trail.

However, because there are so many disparate views of how to deal with overall health care, it's understandable that consumers' views about the ultimate goal of such legislation are muddled. For instance, 28% of left-leaning voters say they want to see health care costs lowered by federal law, and 18% want to broaden access to care. Another 16% want to see lawmakers prioritize upholding the Affordable Care Act and its protections for people with pre-existing conditions, and 15% want to see a single-pay system put into place. Finally, 8% each believe it's most important to cut prescription drug prices and improve women's health care.

With all that in mind, it's important for those in the health care sector to ensure they are abreast of all potential changes that could be enacted in the months and years ahead. It's likely that seismic shifts are on the way, and having contingency plans in place to deal with them as they come is a must for any health care executives.



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