What the Election Means for Healthcare Reform

by Elaine Zablocki, Editor, Great Boards newsletter

Increased Republican power in Congress will mean continuing debate over healthcare reform, but hospitals shouldn’t abandon delivery system reforms, according to Kristin Welsh, Vice President of Federal Affairs for the American Hospital Association. She made her remarks during a webinar on “Post Election Analysis on Health Reform — from Inside the Beltway,” presented last Friday by the QHR Learning Institute.

Welsh predicted that early in the year there’ll be many votes on repealing or replacing healthcare reform, but in the end, Congress doesn’t have the votes to override a Presidential veto. As a New York Times story on Nov. 6 by Robert Pear explained, Republican legislators are likely to withhold appropriations for some of the estimated 100 sections of the law that require funding as well as trying to repeal or scale back provisions that conservatives despise most, such as the individual mandate to buy insurance or the new IRS form 1099 requirements.

“House Republicans could easily pass … provisos stating that no federal money could be used to carry out specific sections of the new health care law,” Pear wrote. “By attaching the restrictions to appropriations bills, House Republicans can force negotiations with the Senate. The Hyde amendment, restricting the use of federal money to pay for abortion, began as such a rider more than 30 years ago.”

“The individual mandate is being addressed at the state level, through the courts, and it remains to be seen how that plays out,” Welsh said. “Obviously it’s very important for us (AHA) that it stays in. That was the crux of our involvement in the reform package at the very beginning.”

Welsh also noted potential opportunities for hospitals as they work as with the newly empowered Republicans in the House. Labor won’t have the votes to pass card check “so we have a reprieve on that issue,” she said. “Liability reform is an issue that clearly resonates with Republicans. The House could probably pass a liability reform bill now but the Senate probably cannot.”

Republicans generally support regulatory relief, and that poses an interesting situation for hospitals, Welsh said. “If regulations are seen as advancing healthcare reform, the Republicans are going to be very skeptical of providing help to those regulations. They don’t want to see reform advance; they want to rein it in. Unfortunately, clinical integration is seen as part of health care reform, so we’ll need to explain this issue in a way that puts it outside the scope of reform.”

Republicans also face particular challenges as they plan their strategy, Welsh said. Since the reform has been counted as money-saving legislation, any attempts to repeal provisions of the bill will require off-setting savings. “It’s a complicated bill, all very intertwined,” Welsh said. “To pull one thread could unravel things you might not want to unravel. I think right now Republican staff must be struggling to figure out how to dismantle this in a thoughtful way.

Back at the start of the debate on health care, provisions on insurance reforms, delivery system reforms and transparency had widespread support on both sides of the aisle, Welsh said. “That’s important,” Welsh said. She urged hospitals to continue preparations for delivery system reforms, because “issues such as ACOs, bundling and gain sharing are not going away. These issues will stay with us, because they are the crux of moving the way care is delivered and paid for.”

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