Now that the election season is over, and the constant barrage of candidate ads have (thankfully) disappeared, I would like to reflect on what the outcome actually means for the health care industry.
As I've shared with everyone else, despite all the media hubbub about the sustainment or repeal of the Affordable Care Act (aka ACA or Obamacare) the outcome of this election was not a key determinant of health care's future. Let me explain why.
First, voter polls showed that the election was clearly about the economy, not health care. You could make the argument that Obama's staunch defense of Medicare actually hampered his election, as Romney won 56 percent of the vote among people 55 or older despite that population opposing his views on Medicare reform by a 2 to 1 margin.
Second and most importantly, is the reality that whoever was elected president would have to turn their attention to some serious short- and long-term decisions to deal with the federal deficit. It's those decisions, not the election itself, that will significantly impact health care.
In the short term, the looming "fiscal cliff" and its associated $1 trillion in automatic cuts will create some hard decisions on major issues such as the expiring Bush-era tax policies, sequestration and the Medicare physician payment fix. I predict that these decisions will likely be extended, at least through next August, to give the new Congress time to craft a comprehensive package of tax, entitlement and deficit-reduction reforms.
Regardless of timing, since the likely spending cuts and tax increases also have the potential to hinder the nation's economic expansion, drive up unemployment and even trigger further recession, legislators will look to trim the deficit in areas with the least amount of pain.
I think that some of the "trimming" will involve changes to both Medicare and Medicaid to ensure their long-term sustainability. It's hard to imagine that any serious legislation to reduce the federal deficit will not involve some negative changes to Medicare and Medicaid beneficiary cost sharing as well as reimbursement reductions to both physicians and hospitals. Both will change the health care landscape in many ways as both citizens and providers are heavily impacted and forced to adjust.
On a longer-term basis, here's where things really get interesting as the Affordable Care Act comes prominently back into play. As I've said and written before, I believe the main points of the ACA are laudable. However, with the heart of this sweeping legislation scheduled to begin in 2014, it's hard to imagine that the solutions to the fiscal cliff will not also have involved some negotiated adjustments to the structure and funding of the ACA.
In other words, expect to see Congress and Obama forced to make some ACA compromises, which is a perfect segue to my final point.
The election was close, and while it was not a driving factor, there is still a sharp divide over how to overhaul our health care system. The debate and decisions are likely to be very contentious and confusing for a long time. My holiday wish this year is for our red and blue legislators to find the courage and unite in a bipartisan "purple" effort and reach consensus on some long-term solutions for health care.
- Larry Sobal is system vice president for cancer and cardiovascular services at ThedaCare. He can be reached at 920-731-8900 or at firstname.lastname@example.org.