Eleanor Kennedy | Nashville Business Journal
Tom Daschle’s hope for the next president’s first big move in health care isn’t so much a policy position. It’s a way of developing policy in the first place.
The former Democratic Senate majority and minority leader wants the next president to regularly bring together stakeholders from both sides of the aisle to find common ground on how to make health care better. He shared that hope with one of his own former cross-aisle foes, former Republican Senate Majority Leader Bill Frist, during a Nashville Health Care Council panel Thursday morning.
Frist, who now often works with Daschle on bipartisan health policy efforts, echoed Daschle’s sentiment, harkening back to President George W. Bush’s efforts to foster bipartisan agreement during his tenure, including frequent breakfasts that were, Frist joked, occasionally “painful,” but worth it.
The pair of politicians were joined in their conversation by two other health care heavy hitters: former Utah governor and Department of Health and Human Services Secretary Mike Leavitt and Nancy-Ann DeParle, a partner with private equity firm Consonance Capital and a former White House staffer with extensive experience related to the Affordable Care Act.
But while the highly experienced lineup highlighted the biggest issues likely to confront the next president, and even mentioned areas where the type of bipartisan agreement Daschle seeks could be possible, Frist raised a caveat: Given the past six years’ intense focus on health care policy, there may be some “burnout” under the next administration related to the issue. During the next president’s first 100 days, Frist said, health care “will be competing with a whole range” of policies.
“We don’t really know where health care will fall in that list,” he continued.
Still, there’s plenty to discuss without knowing when, or how, it might be acted upon. Here’s a look at some of the big things the panelists have their eyes on heading into the final six weeks before the presidential election:
- “Fragile” exchanges. Earlier this week, BlueCross BlueShield of Tennessee announced it would stop offering coverage through Tennessee’s Obamacare exchange in the state’s three largest markets, the latest blow to a model Frist said some believe will “implode within 18 months” without corrective action. The panelists weren’t overly specific in their recommendations to fix exchange issues (though Leavitt said the government has not been as strong a partner as insurers expected, since political forces led to the financial support the government had promised to offer decreased) but seemed to suggest that a way to make the actuarial math behind the individual markets work could more easily be found under the next president, whoever it is, if partisan fervor around the issue can be quelled.
- Medicaid expansion. As Tennesseans well know, 19 states have not expanded Medicaid as called for by the Affordable Care Act. Hence DeParle’s top recommendation for the next president: Help those states “figure out a path” for how to do so. That’s another issue the panelists see time, and a decrease in knee-jerk political reaction to anything tied to Obamacare, shifting. Going forward under new political leaders, the panelists said, the key to getting more states to expand the program will be increasing the flexibility those states have to structure their own model of that expansion. (Tennessee, of course, already crafted its own federally approved unique model, but the Legislature wasn’t interested.) Should Republicans take control, the panelists generally agreed, there will likely be momentum for the overall structure of Medicaid to shift into a block-grant model, which might change that calculation.
- Payment reform. Everybody agrees that fee-for-service, in which providers are paid individually for each procedure they do, is “archaic and outmoded,” Daschle said. But while the general idea of changing that model to paying for value is popular, “there’s a great deal of controversy” when you actually get down to the details. Leavitt does see progress, however, on what he argued is a long journey. “I believe that we are 25 years into a 40-year transformation,” Leavitt said, with the biggest roadblock coming from providers’ mindsets, not government policies. “The whole mentality is having to change here.”