Editor's note: This is the first post from the Nashville Health Care Council's 2014 Leadership Health Care Delegation to Washington. Look for more content in the coming days and click here for other entries from past years' visits.
As the 2014 election season begins to heat up, nearly 100 of Nashville’s emerging health care leaders have gathered in our nation’s capital to get an inside look at the health policy discussions that will shape the mid-term elections and affect the industry throughout 2014 and beyond. During the first day of sessions at the 12th Annual Leadership Health Care Delegation to Washington, D.C., delegates heard from a slate of speakers about topics ranging from health insurance exchange enrollment to new payment and delivery models to patient engagement.
Michael Ramlet, founder and editor of digital media company “The Morning Consult,” kicked off the delegation by discussing what he predicts will be a key factor for the industry and politicians in the coming months — whether insurance exchange enrollment will reach the Obama administration’s projected goal of 7 million. With enrollment estimates now above 4 million and a new set of data expected in the weeks ahead, these figures will help determine whether the ACA can be considered effective.
However, Ramlet (pictured at right) noted that one of the biggest, yet under-reported stories of 2014 has been the number of health insurance exchange enrollees — one in five — who have failed to pay their premiums, meaning they don’t actually have coverage. And keynote speaker Dora Hughes, senior policy advisor in the government strategies group of law firm Sidley Austin (pictured), noted that there will be an estimated 5 million individuals who will not be able to get coverage because their states are not expanding Medicaid or they do not qualify for premium subsidies but still cannot afford premium costs.
The expansion of coverage under the ACA was cited as the best part of the law by a panel of policy experts, although they argued that issues such as timing of the individual mandate and the Supreme Court ruling that made state Medicaid expansion optional have created challenges across the industry.
“What keeps me up at night is coverage expansion, and that it hasn’t happened as quickly as we would have hoped,” said Mary Ella Payne, senior vice president of policy and system legislative leadership for Ascension Health. “We don’t have coverage in Tennessee with the expansion of Medicaid and…many states have not expanded coverage. Related to that are delays that we have been seeing in moving to ACA-compliant plans and delays in the marketplace for small companies.”
Tom Nickels, senior VP of federal relations for the American Hospital Association, said although insurance coverage levels are “nowhere near what we had hoped,” he expects it will take a three-year timeframe for coverage to reach desired levels through Medicaid and the exchanges.
“So I think judgment ought to be suspended at least until we get to the end of 2016,” he said.
In the meantime, Hughes noted that the Centers for Medicare and Medicaid Services’ Innovation Center is working on more than 40 models for improving care delivery in terms of cost and quality, such as accountable care organizations and bundled payments. And although there are more than 260 active ACOs around the country, reports on their effectiveness so far have been mixed.
But one thing is certain. Health care will have a leading role in the 2014 elections.
Ramlet pointed to a poll that shows independent voters evenly spit on which of the major parties they trust more on health care issues. Because of that split, what happens in the months ahead — with exchange enrollment and the perceived value of the health plans, provider experiences, and whether employers drop coverage in favor of pushing employees to exchanges — will be critical.
“There will probably be three big issues,” Ramlet said. “The economy, health care, and the third is open to debate… but health care, you can be sure, will be a major election issue.”
Photos by Keith Mellnick
Tennessee's enrollment numbers in the federal insurance exchange jumped nearly 65 percent between Dec. 28 and Feb. 1, according to the latest report from the Department of Health and Human Services.
By the end of January, 59,705 Tennesseans had enrolled in insurance through the federal marketplace, compared to 36,250 at the end of the 2013. Find the report here.
In the face of criticism from the state Senate’s leading Republican, Gov. Bill Haslam said the key setback in striking a deal expanding Medicaid here is matching up what Tennessee lawmakers will pass and Washington will approve.
“I’m not going to waste their time or our time with a proposal that is either not going to go anywhere in Washington or not going to go anywhere in Legislative Plaza,” Haslam told reporters Wednesday. “We have a very difficult needle to thread here.”
Earlier this week, Lt. Gov. Ron Ramsey said the governor is “wasting his time” trying to pin down a plan to offer healthcare to more low-income people on Tennessee's own terms using federal dollars from the Affordable Care Act. He said problems in Washington implementing the federal healthcare exchanges have convinced him the state should wait about two years before deciding whether to move forward.
In March, Haslam decided to pass up $1.4 billion from the federal government to expand the state's TennCare program to an estimated 180,000 Tennesseans, saying the state can't afford to make the Medicaid program available when Washington begins to phase some of the costs of expansion back to the state. Instead, he said he'd see a unique plan for Tennessee.
When asked by reporters if trying to satisfy both the legislature and Washington in a new plan was “almost an impossible task,” Haslam said “that probably speaks a little to the difficulty, quite frankly.
“I admit it’s a difficult task to find something that we think works for us and that will get approved by them. I don’t think it’s the right thing to do just to throw in the towel, either.”
Health and Human Services Secretary Kathleen Sebelius told reporters last week she has spoken with the governor several times about a Tennessee plan, but has “not seen specifics from the governor’s office.”
Haslam said he has had “specific conversations” with the department, and expects to pitch a plan to the federal government “in a short period of time” outlining what the administration thinks could be acceptable to both parties.
With problems plaguing the federal government’s system signing people up for health insurance, Gov. Bill Haslam said it’s hard to say whether he made the right decision leaving Tennessee’s portal to the feds.
“It’s hard to know the exact answer to that,” said Haslam in Nashville Wednesday. “In the end, we felt like it was their program. They’re the ones who suggested it and it would be better in this initial stage if they ran it. The thought being at the time that having two cooks in the kitchen when you’re trying to put together something that complex would make it that much more difficult.”
At times prior to passing on the exchange, Haslam argued Tennessee could run the exchanges “better and cheaper” than the feds. He later worried the federal government would still control most of the exchange. At the same time, the GOP-led legislature began pushing against taking on a piece of the Affordable Care Act.
Tennessee is one of 27 states leaving the exchanges to the federal government to control. Seven other states partnered with the federal government and 17 independently set up their own. Haslam pointed to mixed results among states that chose to run the exchanges themselves.
Problems with the federal exchanges are complicating Tennessee's other health care decision, he said, which is whether officials can agree on a state-specific plan to take advantage of federal dollars to expand Medicaid. It "would be a stretch" to have a plan to pitch to state lawmakers by Jan. 1, he said, after originally planning the decision could come by summer's end.
“I’m not going to project a date when something may or may not happen. We’re continuing discussions. Like I said, it’s definitely gotten harder in terms of this because HHS (U.S. Department of Health and Human Services), like I said, definitely has their plate full trying to deal with all the issues they have.”
Shares of HCA Holdings have gotten a nice boost from Mizuho Securities analyst Ann Hynes, who this morning raised her rating on the hospital giant to 'buy' from 'neutral' based on the growth prospects that come with health care reform. Hynes also hiked her price target for HCA to $51 from $42, which leaves more than 20 percent of upside from the $41.85 (Ticker: HCA) where they were changing hands early this afternoon.