“It’s a great idea that can’t be paid for,” Thom Tillis, Republican Senate candidate from North Carolina famously said about the Affordable Care Act (ACA). In fact, every winning Republican U.S. Senate candidate in last month’s 2014 mid-term elections campaigned on repealing the law. With elections resulting in a GOP claim of 53 Senate seats to the Democrats’ 46 (Louisiana will hold a run-off on this weekend on December 6) as well as a 56 percent House majority (not to mention four new state governorships), will they resurrect this battle cry? No. Even though polls indicate that a majority of Republican voters disfavor the ACA, there are significant ideas within it that are extremely popular among many Americans, including the expansion of Medicaid, the pre-existing condition clause, insurance subsidies, and coverage of adolescence and adults (up to 26 years of age) on parents’ plans.
The challenge, then, for Republicans over the next two years is to apply free-market principles and state control to “keep the good stuff” while cutting back elsewhere, all while dodging presidential vetoes and keeping an eye on voter opinions as 2016 approaches. This could portend success or suffering for healthcare professionals, depending on their state of residence, skills, and area of expertise.
Two-year cheat sheet: What you need to know about ACA changes:
The Senate Republicans’ most bankable strategy will be to chip away at select provisions for which they can garner Democratic support, such as the employer mandate (which Congress has delayed twice so far), the medical device tax, and the independent payment advisory board (IPAB). Republican governors and state legislatures may slow the expansion of Medicaid in favor of exploring innovative alternatives to the fee-for-service model without Federal financial assistance and without alienating their senior voters. To break down some key issues to see what is meant for healthcare workers:
Slowing down Medicaid expansion
As of August this year, 27 states plus the District of Columbia opted to expand Medicaid through the ACA Federal funding provision. For healthcare workers in states that are not yet on board, this will not have serious repercussions. “Slowing Medicaid expansion would not affect the private or healthcare economies at the state level,” says Hebert Schneiderman, a healthcare consultant in St. Louis with experience in hospital administration and payor enterprises. Patients will continue to get care as required by law, he added, so nurses, doctors, lab techs and the like will stay as busy as usual. Any new healthcare jobs may stem from state agencies as they design innovative ways to fund and administer the expansion mandate without Federal assistance.
Neutralizing the employer mandate
The law states that employers must provide employees insurance coverage that meets the requirements outlined in the Affordable Care Act. “This can be very costly for a small business,” Schneiderman explains, “so an employer may choose to ditch offering the benefit of private insurance and put everyone on the government’s plans.” More enrollees in state-supported exchanges may up the need for plan administrators at the state and Federal levels. Another issue that large and small employers must grapple with is the coverage mandate for full-time employees vs. what the ACA calls the “30-hour work week” mandate. “So if an employer cuts a full-time employee down to 30 hours a week, he can save the cost of that employee’s insurance premiums, pay that worker less and encourage more productivity in a fewer number of hours,” explains Schneiderman. This quandary applies not just to the private sector, but to healthcare businesses that provide insurance to their employees, such as hospitals, urgent care facilities, long-term care homes, labs, and others.
Lowering pay for physicians
In March, 2015, Medicare’s sustainable growth rate (SGR) “patch” is set to expire. To date, the patch has prevented catastrophic cuts in physician pay rates. Cutting pay for doctors, which started with Medicaid in 2004, results inevitably in a shortage of doctors who accept Medicaid and Medicare patients. That in turn affects the jobs supported by a doctor’s office, including nurses, PA’s, building management, malpractice insurance providers, medical equipment maintenance, drug reps and more. “Republicans won’t take on cutting doctors’ fees because there would be a huge backlash from Medicare patients,” Schneiderman predicts. “There’s always a lot of drama with this topic, but I don’t believe reducing doctors’ fees will be a priority in the next two years.”
Exchanges and exemptions
As a healthcare worker, there are two more things you may want to keep an eye out for, says Chas Roades, chief research officer of The Advisory Board Company: a growth in private employer exchanges and states continuing to seek exemption from central tenets of the law. New action on either front could bode well for more healthcare advocacy and healthcare administration jobs.
Tip of the Day
Snack time! If your child says he or she is hungry, offer a healthy snack to tide them over until the next meal.
Daily Inspiration X 2
“When I was a child, I spoke like a child, I thought like a child, I reasoned like a child. When I became a man, I gave up childish ways.”
~1 Corinthians 13:11
“The difference between perseverance and obstinacy is that one comes from a strong will, and the other from a strong won’t.”
~ Henry Ward Beecher