The American Health Lawyers Association released its list of the top 10 healthcare issues for 2018. Not surprisingly, healthcare reform and the status and future of the Affordable Care Act (ACA) came in first. Emergency preparedness, telemedicine and digital health and the opioid epidemic also made the list. The full list appears below, followed by a bit more on the number one issue.
- Healthcare Reform and the ACA
- Fraud and Abuse
- Payment Reform Model Trends
- Medicaid Outlook for 2018
- Hospital Mergers, Acquisitions, and Affiliation Transactions
- Drug Cost/Pricing
- The Opioid Epidemic
- Telemedicine and Digital Health
- Emergency Preparedness
Healthcare Reform and the ACA
The ACA remains the law, but its future is uncertain. Repeal and replace didn’t pass in Congress, but the Tax Cut and Jobs Act repeals the “central pillar” of the ACA—the individual mandate.
Some analysts caution that this will seriously threaten the stability of the individual and small group health insurance markets, including the health exchanges.
The Congressional Budget Office (CBO) estimated that between 4 and 13 million individuals would lose insurance coverage and that premiums in the individual and small group insurance markets would rise about 10% as a result of this provision. Others note that the penalty for failure to have health insurance was never large enough to significantly influence enrollment decisions, so its elimination will not dramatically alter insurance markets. There has been some discussion of Congress revisiting health reform as early as this year.
Outlook for 2018
The authors noted that the Administration has said it expects the ACA to “implode” on its own, even without legislative action. “For now, though, it seems that ongoing uncertainty over the ACA’s fate has not proven too disruptive to health insurance markets. Though major national insurance companies have continued to withdraw their offerings from the exchanges, in 2018, there are no ‘bare counties’ without health plans participating in the exchanges. Early enrollment was better than expected, but ultimately enrollment numbers fell below 2017 levels, likely due to an abbreviated enrollment period, consumer confusion and significant marketing cuts.
“In 2018, issuers will make projections about the effects of the repeal of the individual mandate on enrollment numbers and the risk profile of insureds and will continue tracking exchange enrollment numbers, the shifting regulatory landscape for the exchanges and the likelihood of further legislative changes (whether stabilizing or destabilizing) in deciding on their 2019 health exchange participation and premium rates. Individuals, particularly those without employer-sponsored coverage, will decide whether to take up or retain coverage without the individual mandate. Providers likewise will monitor the impact of the repeal of the individual mandate, other health reform initiatives, and issuer responses on the uninsured rate, Medicaid coverage and reimbursement, and patients’ cost-sharing obligations.” (AHLA Connections, January/February 2018)
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