What Could the Upcoming Midterm Elections Mean for Physicians and Healthcare?

Leigh Page

Disclosures

October 09, 2018

In This Article

Can Parties Compromise on ACA Issues?

The ACA is another possibility for some bipartisanship. Both parties obviously can't agree on the law as a whole, but they might be amenable to quick fixes if the ACA reached a crisis, says Kevin Campbell, MD, a Colorado cardiologist and commentator who often appears on Fox News and CBS.

One such crisis might be a meltdown of the ACA marketplaces, or exchanges, if prices spiraled out of control and members dropped out in droves. "Congress might need to act quickly before more Americans lose their insurance," Campbell says.

However, Campbell thinks the chance to really fix the ACA seems to have already passed. He notes that even many Democrats have moved beyond the ACA and now prefer single-payer.

But Pearl thinks that America can't afford to start all over again with a new healthcare reform initiative. "We need to fix what we have," he says. "Amending the more problematic parts of the ACA is more likely to improve the health of Americans than implementing another set of health reforms."

At the least, parts of the ACA might be preserved. For instance, three quarters of Americans think protecting people with preexisting conditions is "very important," according to a poll released in June.[8]

This could be a sticky issue for Republicans, because the Trump administration has declared itself both for and against the preexisting conditions protection.

As part of an ongoing lawsuit against the ACA, the Justice Department has come out against this protection on legal grounds. But Azar insists that the administration actually supports the protection and urged Congress to pass a bill that would preserve it if it gets cancelled. And Senate Republicans recently introduced such a bill.[9]

Other Possible Compromises

A smattering of other healthcare issues may lend themselves to bipartisan compromise. For example, both Democrats and Republicans have supported moving reimbursements from fee for service to value-based approaches, in which doctors and other providers are rewarded for improved efficiency, better outcomes, and adherence to standard protocols.

Pearl approves of this trend. "The system has to change from one that rewards doctors simply for doing more to one that requires them to do better," he says. He also thinks both sides could agree on the need to promote primary care.

Republicans also want to restructure Medicaid, but Democrats have been less willing to go along here. In 2017, the GOP tried and failed to pass several bills in Congress that would have cut Medicaid funding to the states or changed it into block grants.

Derksen thinks the parties should find common ground on this issue. "Congress should allow states to innovate with less federal interference through Medicaid waivers," he says. But he opposes using waivers to make it more difficult to enroll in Medicaid "by imposing cumbersome work requirements or by not increasing Medicaid coverage for the uninsured," he says.

Republicans also want to shift the Department of Veterans Affairs (VA) from a system of VA-operated hospitals and clinics to one that allows veterans to buy private healthcare. A bill signed by Trump in June 2018 took a step in this direction. Would a Democratic-controlled House allow the administration to make more changes in the VA?

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