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September 21, 2023

Nashville panel: Health care challenges loom for next president

Nashville panel: Health care challenges loom for next president

Holly Fletcher | The Tennessean

The next president’s administration will have to stitch together bipartisan commitment if they intend on tackling health care issues that impact millions of Americans, ranging from the volatility of the federally run health insurance exchanges to out-of-pocket costs and Medicaid expansion, a high-powered panel of political and industry experts said Thursday in Nashville.

Health care will be competing with a variety of national issues for the early attention of the next administration. And yet former Sen. Bill Frist, R-Tenn., who led a panel hosted by the Nashville Health Care Council, said he expects “natural reluctance” from either party to elevate the issue too high given the hotly contentious nature of health care reform efforts over the past several years.

The recent decision by BlueCross BlueShield of Tennessee to stop selling individual plans in the state’s three largest metro areas underscores the fragility of the marketplace, said Mike Leavitt, the former Republican governor of Utah.

Exchanges are “probably a good thing, a good idea,” and the current problems are “fixable if we can get through the partisanship,” Frist said.

Leavitt said the government’s focus should be on the federal guidelines, or the mechanism that allows the marketplace to function.

Some of the problems are similar to those of Medicare reform in the 1990s, but instead of the government working out the issues, it’s largely being left to the industry.

Yet, the government hasn’t been able to follow through on some of its original plans, Leavitt said, noting that partisanship was a factor in less money coming from the government to stabilize the exchanges.

“The government hasn’t turned out to be a very good partner,” said Leavitt, who was secretary of the U.S. Department of Health and Human Services under President George W. Bush.

Panelists urged the next president to convene weekly meetings for top congressional and health care leaders to get people talking about issues to find consensus. A weekly breakfast with the president goes a long way to forcing bipartisanship, said Frist, noting “people will respond to the president of the United States.”

Hillary Clinton and Donald Trump have talked about health care costs and the need to limit out-of-pocket costs for people, Frist said.

But at this point in the election there is a clear priority list from Clinton, while Trump’s plan — beyond repealing and replacing the Affordable Care Act — is less clear, speakers told the audience.

“Candidate Trump has no health care plan. He has seven bullets. Secretary Clinton has 35 pages in great detail so it’s hard to know what (Trump is) going to do,” Frist said.

Panelists said Medicaid expansion will emerge as an early priority for the new president. There are 19 states, Tennessee included, that haven’t expanded, often as a protest by the legislature of the ACA, panelists noted.

“I believe that a President Clinton would be able and willing to negotiate to get Medicaid expanded,” Leavitt said. “A President Trump, I don’t know.”

Tom Daschle, a former U.S. senator from South Dakota, said there is “at least a 50-50 chance” that Trump and a Republican Congress would implement block grants for a state Medicaid program although he thinks that would be a negative.

Nancy-Ann DeParle, partner at Consonance Capital and one of the architects of the ACA, said the administration knew there would be some states that probably wouldn’t expand until President Barack Obama left office.

It’s important though, at this juncture, for the next administration to negotiate with states on programs that reflect their values, Leavitt said.

“It’s not just a health calculation for most governors,” Daschle said. “It’s an economics calculation.”

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