Modern Healthcare
May 21, 2016
Here's what CEOs think of candidates' healthcare ideas
By Shannon Muchmore
The CEO Power Panel includes 110 top leaders of hospitals, insurance companies, physician groups, trade associations and other not-for-profit advocacy groups. The second-quarter survey on policy options that the next president and Congress might address attracted 86 respondents, a 78% response rate.
Future of ACA
Do you support Congress and the next president in:
Repealing and replacing the Affordable Care Act?
2.3% - Yes
67.4% - No
29.1% - It depends on the details
1.2% - No opinion
Expanding the ACA's subsidized private insurance plan system to achieve universal coverage?
34.9% - Yes
15.1% - No
48.8% - It depends on the details
1.2% - No opinion
Scrapping private insurance in favor of expanding an enhanced Medicare to cover the entire population (single payer)?
9.3% - Yes
61.6% - No
29.1% - It depends on the details
Other insurance issues
Allowing private insurers to sell individual and family policies across state lines under national rules that preempt state rules?
52.3% - Yes
20.9% - No
24.4% - It depends on the details
2.3% - No opinion
Expanding the use of health savings accounts to pay premiums and meet costs under high-deductible plans?
74.4% - Yes
11.6% - No
12.8% - It depends on the details
1.2% - No opinion
Creating subsidized high-risk pools to cover people with preexisting conditions?
43.0% - Yes
16.3% - No
36.1% - It depends on the details
4.7% - No opinion
Medicare
Raising Medicare eligibility to age 67?
54.7% - Yes
23.3% - No
22.1% - It depends on the details
Expanding means testing within Medicare, such as higher co-pays or reduced benefits for high-income seniors?
50.0% - Yes
18.6% - No
30.2% - It depends on the details
1.2% - No opinion
Moving to a universal Medicare Advantage system with a means-tested defined contribution (premium support) for seniors?
28.2% - Yes
20.0% - No
48.2% - It depends on the details
3.5% - No opinion
Gradually expanding Medicare to cover everyone over age 55 who doesn't have private insurance?
21.4% - Yes
48.8% - No
28.6% - It depends on the details
1.2% - No opinion
Delivery system reform
Taking aggressive measures to curb rising prescription drug prices such as allowing imports and authorizing the CMS to negotiate prices?
70.6& - Yes
9.4% - No
20.0% - It depends on the details
Repealing delivery system reforms such as value-based payment, accountable care organizations and the use of quality measures included in the Affordable Care Act?
03.5% - Yes
83.5% - No
11.8% - It depends on the details
01.2% - No opinion
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Comment by Don McCanne
This poll of selected "top leaders of hospitals, insurance companies, physician groups, trade associations and other not-for-profit advocacy groups" can give us a rough idea of where the executive leadership of the health care industry stands today on health care reform. A few conclusions:
* These CEOs strongly support the Affordable Care Act (ACA). That is not surprising since these vested stakeholders were part of the process that created the legislation.
* They are uncertain on whether or not the private insurance plans should be expanded to achieve universal coverage, although one-third would agree with they should be. The majority may be concerned about the potential of being required to cover care for those with greater health care needs (adverse selection) without being able to transfer risk elsewhere.
* Over 60 percent oppose replacement of private plans with a single payer enhanced Medicare for all and another 30 percent say that it depends on the details. Only 9 percent support single payer outright. This suggests that ACA was indeed designed with these stakeholders in mind, rather than for the patients.
* At least three-fourths support health savings accounts, tacitly supporting high deductible health plans that are a source of financial hardship for far too many individuals who have health care needs.
* At least half support selling insurance across state lines even though that is not practical because of problems such as building new provider networks in other states.
* Close to half support creating subsidized high-risk pools to cover people with preexisting conditions, even though the experience with state high-risk pools has been very disappointing. They are too expensive so benefits have been too meager. Besides they have been unable to cover most eligible individuals in spite of the need.
* Over half support raising Medicare eligibility age to 67, cutting back on coverage when we need to do is increase it instead.
* They would expand means-testing of Medicare, risking support of higher income individuals for the program.
* Somewhat surprisingly there is less support for Medicare vouchers for private plans (premium support), but perhaps that is due to the fact that the premium support strategy is designed to eventually reduce government payments for Medicare. After half of a century, Medicare is here to stay, and the stakeholders do recognize the need for adequate government funds to support the program.
* Only one-fifth support allowing individuals the option of enrolling in Medicare at age 55. Half are clearly opposed. They do not want to displace employer-sponsored plans presumably because they pay higher rates than does Medicare.
* By far the strongest support is for "delivery system reforms such as value-based payment, accountable care organizations and the use of quality measures included in the Affordable Care Act." Evidence to date with these "value over volume" proposals has been disappointing, demonstrating little savings and negligible impact on quality. One possible reason they may be popular for CEOs is that their companies have learned to game the system to collect the rewards offered by these programs.
It is likely that most of these CEOs are relatively conservative politically since they predominantly support policies advanced by the "repeal and replace" Republicans, even though they do support ACA. They also strongly oppose Medicare for all single payer in spite of it being supported by a majority of Americans. Some of the policies they support would make access and affordability worse for patients, yet these policies can be self-serving for their own entities.
This survey of health industry CEOs leads me to the conclusion that the wrong people were sitting at the table when ACA was designed. For our redo, we need people at the table who represent patients rather than the health industries. A system that takes care of patients automatically takes care of legitimate stakeholders, but the reverse has not been true. It's time to change. Single payer.
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