LHC in DC: On the numbers, expansion and politics of health insurance

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

Mar 11, 2014 6:55 AM

Is Bob Corker going to be your governor?

Roll Call suggests the junior senator may be looking at the statehouse:

“Sen. Corker is sometimes very frustrated with the process in the Senate, he is someone whose mindset is executive oriented,” one Tennessee GOP operative said. “He’s got an impressive private sector background and he’s used to getting things done, and that is the antithesis of the Senate.”

Mar 6, 2014 8:32 AM

Lawmakers agree to vague recommendations for third-party ballot access

Legislature has debated issue for years with little movement
Jan 14, 2014 6:00 AM

Alexander campaign continues to lasso GOP leaders

Former Tennessee GOP chairs to serve as honorary co-chairs
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Alexander sets $3M target from state fundraising events

Local finance co-chairs include an Ingram, Waller partner
Jan 29, 2013 3:26 PM

Bader to head up communications for major GOP group

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Jan 8, 2013 12:01 PM

Goba, gearheads and GOTV

Local social media start-up Goba has teamed up with American Majority, a conservative get-out-the-vote organization, to get in front of millions of NASCAR fans between now and the fall. Goba is providing an app and other services to help American Majority Racing communicate with race fans.

SEE ALSO: Politico's profile of American Majority Racing

Apr 12, 2012 12:50 PM

On health reform's election influence

A Nashville Health Care Council panel this week took a close at the state and future of health care reform. Among its discussion points was how the Supreme Court will this spring address challenges to the law — as well as how that might influence turnout in November's presidential election.

“If the individual mandate is struck down, Republicans would be jubilant,” said Tevi Troy, senior fellow at the Hudson Institute. “But it would mobilize the Democratic base to reelect President Obama, in the hopes he could nominate judges who would shift the court’s balance. If the individual mandate is upheld, that could likewise galvanize the GOP base in an effort to elect a Republican president.”

Mar 16, 2012 7:02 AM

More Volunteers for Perry

Rick Perry gets some endorsements from some Tennessee lawmakers. The full release is here.

Texas Gov. Rick Perry today announced the endorsement of six Republican Tennessee lawmakers, including Senate Republican Caucus Chairman Bill Ketron of Murfreesboro, State Sen. Brian Kelsey of Germantown, State Sen. Jim Summerville of Dickson, House Speaker Pro Tempore Judd Matheny of Tullahoma, State Rep. Don Miller of Morristown and State Rep. Mark White of Memphis.

Nov 7, 2011 11:48 AM

D.C. judges uphold ban on foreign campaign dollars

The Legal Times reported late yesterday on a landmark case affecting, well, just about everybody.

A three-judge panel in Washington D.C. has upheld the constitutionality of the ban against foreign citizens donating money to candidates in state and federal elections. Interestingly, a lawyer is at the root of this case. Benjamin Bluman, an associate with New York City firm Sidley Austin, sued the Federal Election Commission in U.S. District Court of the District of Columbia, arguing the ban violates the first amendment.

It seems we have enough trouble policing our own folks in this regard. What would it be like if the entire world was allowed this level of participation in our political process? Click here for the case history details including the relevance of the Bipartisan Campaign Reform Act of 2002, which prohibits foreign nationals from making campaign contributions.

Aug 9, 2011 11:16 AM