Despite a deep divide over the Affordable Care Act between Democrats and Republicans, analysts say lawmakers will need to find common ground on several key issues during the next administration, and there are also several areas where opportunity for bipartisanship could show itself. That's according to Health Affairs authors analyzing the political horizon for the next several years.
It's no secret that the ACA is one of the most polarizing healthcare policy issues in history, pitting Democrats who laud the law's reduction of uninsured Americans against Republicans who continue to openly advocate for repealing the legislation.
The current presidential candidates fall right along those party lines, with Republican nominee Donald Trump also professing his plans to repeal the ACA and Democrat Hillary Clinton saying her plan is to build on the law and make some changes like further expansion of Medicaid, and the option for those approaching 65 to buy into Medicare.
But Health Affairs authors stress the importance for lawmakers of the next administration to look beyond those ideological divides and seize opportunities for bipartisanship in working with existing laws and drafting new ones.
More importantly, they listed a number of areas where opportunities for bipartisanship could be.
For one thing, they note that there have already been bipartisan changes to the Affordable Care Act, and there is interest in other areas including streamlining employer reporting requirements, and removing restrictions on small businesses offering their employees Health Reimbursement Accounts to cover premiums and out-of-pocket expenses.
The high costs associated with of patients who have multiple chronic conditions and "complex social needs" has shined a spotlight for lawmakers on how to find solutions and improve care coordination for these patients. Recent research indicated that interventions like better care coordination, and duel integration of traditional health services and long-term services for those with dual eligibility for both Medicare and Medicaid, brought about reductions in hospital admissions and emergency department visits. This in turn meant increased availability of long-term services and support, they wrote.
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"This evidence, when viewed through the lens of recent efforts to find consensus on long-term care financing, may prompt broader discussions about the link between targeted care management, integration of services for high-need patients, and expanded access to LTSS."
There has also been increased outcry from lawmakers on the high cost of pharmaceutical drugs, and supporting efforts to lower prices and innovate will be top of mind as the share of personal healthcare spending attributable to these drugs continues to rise. In 2015, that share topped out at 16.7 percent. Some lawmakers have already started looking into how to promote competition and access to lower-cost drugs, Health Affairs wrote.
Value based insurance design is another area that could see increased cooperation in the future. Right now, the attention is on the transition to value-based care away from the traditional fee-for-service model as it pertains to provider incentives. However, the call to align consumer incentives to speed the transition is starting to be heard as well. Authors noted that barriers still exist when it comes to restrictions in Medicare Advantage to vary patient cost-sharing, as well as fee-for-service Medicare and alternative payment models like accountable care organizations. However the reality that the system is clearly moving toward value and quality and aware from blanket, traditional models is undeniable, Health Affairs said.
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Authors also highlighted some existing bipartisan efforts that are gaining traction, including the Senate Finance Committee's Chronic Care Working Group's efforts to finalize legislation to bring before the committee that is focused on "advancing team-based care and empowering individuals and caregivers in care delivery." The Working Group put out the proposals in 2015 for public comment.
"Programs to support home-based primary care and policies to provide and coordinate non-clinical services with clinical services through Medicare Advantage and accountable care organizations have been proposed through bipartisan, bicameral legislation," bloggers pointed out.
There has been support for promoting technology like telehealth. Authors wrote that current bipartisan legislation looks to expand the use of telehealth and remote patient monitoring services, possibly by removing restrictions for qualifying participants in APMs and Medicare Advantage to use it.
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"Regardless of the election outcome, there will be opportunities for bipartisanship to address healthcare issues. They may be more incremental in nature and differ depending on the makeup of the Congress and administration. Whether the political will exists to reach across the aisle and work together remains to be seen," Health Affairs authors wrote.
Twitter: @BethJSanborn