May 5, 2017

The day before the House of Representatives voted to pass the American Health Care Act, a group of health care policy experts gathered at the Dornsife School of Public Health to walk through the past, present and future paths to health reform in the U.S.

The event, hosted by the Department of Health Management and Policy, was the third in a series of discussions hosted by the school related to public health issues under the new administration.

Robert Field, JD, PhD, MPH, professor of Health Management and Policy at the Dornsife School of Public Health and professor in the Kline School of Law, started off by describing historical health coverage themes, noting that the American public "always wants to see changes in health care,” but “it's not assured that these plans will always be there." For example, in 1988, President Reagan proposed a health care plan to cover catastrophic illnesses. The law was repealed a year after being enacted, said Field.

Field noted that reform proposals seem to succeed with business and association support. He pointed out that the pharmaceutical industry, American Medical Association, insurers and hospitals were on board with ACA, but many of these groups were vocally united against the AHCA.

David T. Grande, MD, MPA, assistant professor of Medicine at the University of Pennsylvania, explained current political and economic challenges, one of which is how “the Affordable Care Act is shifting how we pay for health care.”

Grande asked the audience whether we, as a nation, are striving for "access to coverage" or "coverage"?

While walking through the uncertain future of the Affordable Care Act, Dylan H. Roby, PhD, assistant professor of Health Services Administration at the University of Maryland School of Public Health, advised the audience not to think of it as "repeal and replace.” Notably, the AHCA bill would change the formula for funding everyone on Medicaid, not just those participating through the Medicaid expansion.

Roby looked ahead and provided key items to watch for:

• Congressional delegates from Pennsylvania, California, Arizona or from other states that participated in the Medicaid expansion who may be undecided.
• Some elements within the approved AHCA bill will be "very difficult to pass in Senate", particularly items that are not relevant to budget reconciliation, as they would need 60 votes to pass the Senate.
• Important decisions related to cost sharing reduction that, he noted, could resurface during tax reform.
• CHIP Reauthorization that will happen in Fall 2017. According to Roby, it's a "must-pass bill for Democrats.”