Presidential election: 4 things managed care should watch

As the 2016 presidential election approaches, analysts and experts are advising healthcare executives to watch and monitor certain issues, such as pharmaceutical spending and healthcare reform, which will surely impact the health insurance industry. Here’s a look at what they recommend keeping a close eye on in particular.

Issue #1: The future of Obamacare

The healthcare agenda of Donald J. Trump, would-as currently outlined-benefit both insurers and healthcare providers, claims Sally C. Pipes, president and CEO, Thomas W. Smith Fellow in Health Care Policy, Pacific Research Institute, San Francisco, California. First, Trump would repeal Obamacare and reduce the burden on insurers who are losing significant money from participating in the marketplace exchanges, Pipes says. Insurers would no longer lose millions of dollars due to poor enrollment numbers under Obamacare and the fact that not enough young, healthy individuals have enrolled to cover the cost of coverage for older and sicker members.

Secondly, Trump would get rid of restrictions on the interstate sale of health insurance so that individuals who live in high-cost states could buy coverage from lower-cost states. “A national market would reduce restrictions on insurers regarding where they can sell and would allow them to expand their consumer base,” Pipes says.

Thirdly, Trump wants to promote tax-advantaged health savings accounts (HSAs), which debuted in January 2004. “This will not only help consumers, but also employers,” Pipes says. “HSAs allow individuals with high-deductible health plans to set aside tax-free money for healthcare expenses. Trump would also allow funds to be passed onto the next of kin tax-free following the death of an HSA holder. Having consumers save more of their own funds for healthcare would lessen the burden on employers to cover the cost of healthcare.”

Meanwhile Hillary Clinton wants to build on Obamacare-dubbed Obamacare 2.0. She would place even more mandates and regulations on hospitals, insurers, and healthcare providers. “Among her agenda items are to pad healthcare plans with additional ‘free’ services,” Pipes says. “She wants to require insurers to provide members with three complimentary sick visits to a doctor annually, in addition to the preventative care mandates already included under Obamacare.”

Furthermore, she would block insurers from charging more for out-of-network providers who work at in-network hospitals or for any emergency services, regardless of where they are delivered. “Standardizing prices for even out-of-network providers would be costly for insurers,” Pipes says.

Clinton's “Medicare-for-more” plan, which would allow Americans 50 and older to buy into Medicare, is also a stone’s throw from “Medicare-for-all”-the first step toward a single-payer healthcare system, says Pipes. “More government involvement spells bad news for the healthcare industry.”

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