ACA repeal failure: 5 action items for healthcare execs

Now that the Graham-Cassidy bill has failed, here’s what healthcare executives should do to plan for 2018.

1. Recalibrate product portfolio, networks and service areas for 2019.

Steele

“Soon after open enrollment is finished, plans will be planning for 2019,” says John Steele, partner at HealthScape Advisors consulting firm. “Insurers should take a close look at how product selection and competitive landscape changes are impacting 2018 enrollment and infuse into their 2019 planning.”

2. Offer practical insight to policymakers about what makes sense. 

“Managed care executives are where the rubber literally meets the road, but they need to separate out Medicaid expansion issues from the ACA market products,” says Jay Wolfson, DrPH, JD, distinguished service professor, Public Health, Medicine and Pharmacy, and senior associate dean, Morsani College of Medicine, University of South Florida Health. “If the Administration permanently elects to not enforce the individual ‘tax’ for not acquiring insurance and further elects to limit or discontinue subsidies-and there is a legal basis for that determination-then elements of the ACA will become increasingly dysfunctional. This will not only harm beneficiaries who cannot afford to use, let alone policies-but providers and insurers who have planned to rely on the premium payments and service revenue.”

Wolfson

3. Set business plans for the next two to three years.

Bob Atlas, a strategic advisor and president of consulting firm EBG Advisors, Inc., calls this time a “moment of relative clarity in public policy.”

“Choose targets that suit your company’s core competencies rather than leap into unfamiliar realms,” he says. “But try to diversify your portfolio to protect against political risks, not just underwriting risks.”

4. Focus on enhancing population health and reducing cost of care.

“Regardless of any action in D.C., the cost of healthcare continues to rise across all segments,” Steele says. “Most of the financial turnaround in the industry has been through pricing. Going forward there will be limits to how much insurers can continue to price into their products due to affordability.”

5. Increase exposure to Medicare Advantage. 

Atlas

“Demographic trends, changes to Medigap in 2020 and reimbursement structure makes Medicare attractive relative to other market segments,” Steele says.