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Health Reform X.0 Panel Debates Medicaid, Other Topics at Health Policy Conference

Allison Inserro
Are Medicaid waivers meant to encourage able-bodied adults to work, or a return to poor laws of old? Or are they a means to get states that have not expanded Medicaid to expand? A diversity of viewpoints on these and other topics were on full display during Health Reform X.O: What Now, What Next?, the first session of AcademyHealth’s National Health Policy Conference.
Are Medicaid waivers meant to encourage able-bodied adults to work, or a return to poor laws of old? Or are they a means to get states that have not expanded Medicaid to expand?

A diversity of viewpoints on these and other topics were on full display during Health Reform X.O: What Now, What Next?, the first session of AcademyHealth’s National Health Policy Conference, in Washington, DC.

Moderator William Hoagland of the Bipartisan Policy Center led a discussion about events in healthcare over the past year, from changes in the Affordable Care Act (ACA) to Medicaid and the Children’s Health Insurance Program (CHIP), to last week’s news about Amazon, JP Morgan, and Berkshire Hathaway forming a health partnership.

The panelists included Sara Rosenbaum, JD, of the George Washington University School of Public Health; Gail Wilensky, PhD, economist and senior fellow from Project HOPE; Michael Heifetz, former director of Wisconsin’s Medicaid program and currently with Michael Best Strategies; and Jeanne Lambrew, PhD, senior fellow at The Century Foundation.

Before asking panelists to look forward, Hoagland asked them to look backward and share their thoughts about the year that happened since the last health policy conference, citing the Affordable Care Act (ACA), which President Trump had vowed to repeal and replace. While that did not happen, the individual mandate was removed as part of his tax reform legislation in December 2017.

“I think last year certainly for me was the most existential I had been through in 40 years here,” said Rosenbaum. She said, “proposals became unmoored from the facts underneath,” and said no better example of this is the debate over Medicaid.

However, “what emerged over time is that Medicaid is the DNA of the American healthcare system,” Roseenbaum added. Medicaid came out stronger, even if reform is needed.

As a result of the debates over the past year, Wilensky said it has clearly been established that Medicaid coverage is here to stay, but said that it has also “graduated to be a program that people criticized it for when it was never intended to be a program for low income or poor people.” As a result of the ACA, it covers a wider range of people, and both Republicans and Democrats pushed back when faced with the prospect of people losing coverage, which she views as a positive thing.

“The old Medicaid is not coming back,” Wilensky said.

She urged her fellow panelists to “stop moaning and groaning” and pointed out that it shows that any legislation that does not have bipartisan support is not likely to be stable.

Wilensky cited the Amazon-JP Morgan Chase-Berkshire Hathaway announcement last week as one example of frustration on the spending side, and said her immediate response to the news was, “Why do you think you will do better than CalPERS?” referring to the California Public Employees’ Retirement System (CalPERS) which also has a million covered lives.

She said the Amazon partnership may do fine at treating the majority of their employees who spend the least amount of money on healthcare, but it remains to be seen what impact they will have on the small minority of workers who make up the bulk of healthcare spending because of complex, high-cost chronic conditions.



 
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