September 2016

Both presidential nominees have big plans for changing the health insurance world, but hurdles are many and victory on November 8 is only the beginning. Here’s what may be in store.
Joseph Burns
This year’s two presidential nominees have taken aim at high drug prices — and pharma. A solution may require not just rhetoric but cooperation between industries.
Jan Greene
Divided into many different pressure groups, physicians mostly can live with the ACA. But now they have MACRA, MIPS, APM, and other puzzles to figure out.
Richard Mark Kirkner
Trump’s promise to repeal and replace the ACA could cut into revenues, but so could Clinton’s proposal for a public option. Readmission rates, bundled payments, ACOs — they fly under the radar of presidential politics and may continue regardless of the election results.
Robert Calandra
Clinton has come out against the Cadillac tax, but what will replace the revenue? If the ACA is repealed, House Republicans have proposed capping the tax exemption for health benefits as a way to curb the appetite for expensive health care benefits.
Charlotte Huff
Clinton wants to expand the existing program. Trump’s signals are mixed, but the Republican platform calls for replacing entitlements with premium support to buy private health insurance.
Robert Calandra
MediMedia Research survey of our readers shows that they are evenly split on the nominees, and opinions on the ACA span the favorability spectrum.
The ACA was health care reform that left the health care system largely intact, says Princeton sociologist Paul Starr. A Clinton presidency could mean important adjustments to the law, including addressing the omission of a public option. Trump’s proposals would, in his view, effectively end regulation of insurance, and responsible insurers should be worried about fraudulent forms of insurance entering the market.
Interview by Peter Wehrwein
Medicaid expansion often means a hollow benefit, says Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute and a leading conservative expert on health care policy. And the exchanges are in trouble with little political support. But Gottlieb says there will be some reluctance for sweeping reform because of a “fatigue factor,” so targeting the exchanges may be the best way forward for Republicans.
Interview by Peter Wehrwein
Medicaid expansion often means a hollow benefit, says Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute and a leading conservative expert on health care policy. And the exchanges are in trouble with little political support. But Gottlieb says there will be some reluctance for sweeping reform because of a “fatigue factor,” so targeting the exchanges may be the best way forward for Republicans.
Interview by Peter Wehrwein



Departments
9 million Americans buy health insurance outside the ACA exchanges. They make too much money to be eligible for subsidies and can often get coverage with a broader network of providers.
Susan Ladika
Tomorrow’s Medicine
HeartFlow says its algorithm can reduce the need for invasive angiograms by crunching data collected by noninvasive CT angiograms.
Thomas Morrow, MD
Value-Based Care
The law was supposed to give drugmakers freedom to share health care economic information about their products. Efforts to get clarity from the FDA are stepping up.
Michael D. Dalzell