Insight, analysis & opinion from Joe Paduda

< Back to Home


Healthcare in 2018

2017 will be a very misleading year.

There will be no changes to health reform, markets, Exchanges, Medicaid, or Medicare. More people will be insured, hospitals and health systems will enjoy financial stability, and while losses in the individual market for the big five insurers will increase somewhat, work comp will prosper.

This will lead some to think everything’s fine, there’s nothing to worry about, it’s all good, I and others worrying about health care’s future are hysterical Chicken Littles.

Let’s summarize.  There are two general scenarios; GOP repeals ACA’s main components without addressing system-wide fallout, or GOP essentially re-brands ACA (TrumpCare, anyone?) leaving much of the current ACA in place.

If the GOP repeals ACA via reconciliation and/or without:

  • replacing it with an enforceable mandate,
  • maintaining changes to Medicare fee schedules and reimbursement,
  • maintaining the Medicaid expansion,
  • maintaining cost-sharing subsidies for the near-poor, and
  • restoring DSH and other supplemental hospital/health system funding.

This is what we’ll get.

Implications are obvious;

  • cost-shifting to private insurance, workers’ comp, and other property and casualty insurance increases
  • claim shifting increases
  • job lock increases as people don’t leave their employer for fear they won’t be able to get or afford health insurance
  • individual bankruptcy rates increase

I must admit to a morbid fascination with the game that’s playing out.  I’m both embarrassed to admit that fascination and appalled by the damage that will be done to people, businesses, cities and states by the combined ideology and ignorance of our newly-elected House, Senate, and President.

As friends and colleagues keep telling me, we don’t KNOW what these worthies will do.

True, but we can read policy papers, previous proposed legislation, and statements of incoming officials, all of which point to dramatic changes to healthcare. This may well not happen, as those now in positions of power may decide ACA isn’t so bad after all. 

Their constituents have certainly changed their tune, with barely half of the Republicans surveyed looking to repeal “Obamacare”.  Then again, many didn’t know that “Obamacare” and ACA are one and the same.

I don’t think the “repeal and destroy” scenario indicated by those papers and statements will happen, because the real-world impacts would be so damaging.  It appears most on the Hill are leaning towards leaving much of ACA alone, tweaking around the edges, declaring victory and moving on.

Then again, I didn’t think Donald Trump would be President.

If the “tweak and rebrand” strategy wins out, there’s still an awful lot of uncertainty.  The healthcare “system” is a Rube Goldberg contraption like the one where you hit one button and out pops a dollar bill, but if you hit that button while holding down the shift key, you get punched in the face.


What does this mean for you?

Yes, this is really complicated and sometimes hard to unpack.  Don’t fall into the trap of willfully ignoring what’s going on in healthcare, as the implications for you and your business are huge indeed.

5 thoughts on “Healthcare in 2018”

  1. Looks like they are not going to do anything to ACA until year 3 of the Trump Presidency. As with everything in Congress they will fiddle around and do nothing; they are to focused on their reptilian instincts of being reelected and still befuddled by the Trump win. Meanwhile my budget is being busted out by out of control out of pocket health costs; this is something that needs to be addressed through additional, secondary insurance to cover at least 80% of out of pocket. We are hurting out here!

  2. Joe:
    Since the election your blog has taken on the format of the NY Times. All hypothetical and pontifical conjecture over doom and gloom possibilities! I note the polls you sited about ,” Republican constituents have certainly changed their tune” and “Obamacare and ACA are one and the same ” were conducted by CNN. Are they the same pollsters CNN used for predicting the election results? Probably about as reliable!
    Perhaps all of this “sooth-saying” provides you with an avenue to vent your anger over the election. Where does it get any of us in the long run?

    1. Hi Joe – always good to hear from you; much as I’d like to believe your comparison of MCM to the New York Times is complimentary, I have a suspicion it isn’t! Alas, I look forward to getting back in your good graces.

      Allow me to respond to your points after addressing the anger issue.

      I’m past that, and well into the “now what” stage. Am I appalled that Trump will be in the White House? Sure, but that’s reality, and venting about it is not going to change anything. What is important now is this – what will his election mean? How will it affect the health care industry? healthplans? work comp? health care providers? employers?

      That’s my focus. And it’s what two of my large payer clients are asking me to work on as well. So, some of the work I’m doing for them shows up here.

      First, given the rather significant changes we are looking at, it behooves us all to think thru potential implications – which are significant indeed. You’re absolutely right – this is conjecture – however by handicapping the likelihood of potential scenarios becoming reality, and exploring the impact of those scenarios we can be better prepared.

      Second, I noted there are TWO potential broad scenarios; a “repeal and don’t replace key parts of ACA vs rebranding of ACA as something else. I suggested the latter is more likely, due in large part to the very real – and very big – problems that will arise if unintended consequences aren’t fully considered as would happen under “repeal and don’t replace”.

      Third, my concerns about the repeal are real, and aren’t just mine. Both national hospital associations have expressed grave concerns over “repeal and don’t replace key parts” as have insurers and the AMA.

      Fourth, re the poll on the change in self-identified Republicans’ view on the future of “the health care law” was conducted by the Kaiser Family Foundation, not CNN. KFF’s polls on the public view of ACA have been cited by opponents and proponents of ACA over the last several years. It’s certainly possible the latest poll is an anomaly; we’ll have to see what the next one says. That said, the details of Republican respondents’ views are worth considering, particularly the percentage that want the law “scaled back” has increased from 11% to 24%. This isn’t surprising, as most everyone wants kids covered to 26 and no lifetime limits on medical care, pillars of ACA that Trump himself has said he supports now.

      (the other poll was conducted by CNBC)

      Side note – about a third of Republicans polled by Gallup in May favored single payer.

  3. Joe:
    Thanks for the thoughtful response. Forgive me but I do not have a great deal of faith in most polling data without knowing the who, what, when, where and why about it!
    I am certain many republicans believe there are positive aspects to the ACA and if their intent is to maintain them in the system, the most logical way to do that would be to change the existing law rather than a complete repeal. I wanted to add the thought that the same would not be true with Obamacare, but then many of your readers would believe that I did not know they were one in the same!
    MCM is a better read than many parts of the Times!

    1. Joe – as one of the most thoughtful, intelligent, and engaged conservatives I know, I respect and value your views and perspective. I’ve learned a lot from you and look forward to even more education.

      Re polling data – you are, of course, completely correct. Damn it!

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



© Joe Paduda 2019. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.