The Lawyer Will See You Now: Bandy on the Big Questions

[Isaac:] What do we know about how the new administration’s policies will impact the Affordable Care Act?

[Hailey:] President Trump has repeatedly said that he wants Congress to repeal and replace the ACA in its entirety, and many Congressional Republicans support that effort. But vowing to repeal the ACA is much different than actually doing it. From a technical standpoint, the biggest hurdle to full ACA repeal is that the Republicans do not have a 60-vote supermajority in the Senate. They have to rely on a special budgetary process called budget reconciliation, which allows them to pass legislation with a simple majority (51 votes). But that process has its own challenges and limits to what they can repeal. And from a practical standpoint, the biggest hurdle to full ACA repeal is the fact that there is no consensus on a replacement plan.

In light of those limitations, the President is doing what he can through executive order – specifically, he has directed federal agencies to take whatever steps they can to minimize the impact of the ACA on individuals, states, insurers, etc. This is a big deal in that it confirms that the Trump administration is going to do what it can to repeal the ACA. But, overall, the executive order is largely symbolic, and any regulatory change will have to go through the regulatory process, which takes time and requires stakeholder input.

[Isaac:] How will these regulatory changes impact Utah?

[Hailey:] Although it is unclear what specific regulatory changes the Trump administration will pursue, there is a high likelihood that those changes will impact Utahns in a very real way—such as the type of essential health benefits Utahns receive from their insurance plans, the exemptions Utahns obtain from federal requirements like the individual mandate, and Utahns’ eligibility for Medicaid. These rules impact all aspects of health care, which is why the rulemaking process is just as important as the lawmaking process. As they say, the devil is in the details, and federal agencies work out those details.

[Isaac:] What is your take on the various plans that are floating around to replace the Affordable Care Act?

[Hailey:] There are indeed a lot of plans floating around—a dozen or so. Plans that are currently being considered include President Trump’s “Health Care Reform to Make America Great Again,” the House Republican’s “A Better Way” plan, and HHS Secretary Tom Price’s “Empowering Patients First Act.” Although they have many similarities—like offering Americans tax credits or tax deductions, privatizing Medicare, rolling back Medicaid expansion, and eliminating the individual and employer mandates—it’s not clear that any of them have the support to pass Congress.

But to be fair, replacing is a huge task—drafting legislation that ensures people who have health care coverage from the ACA do not lose that coverage, that protects the health insurance market from a death spiral, and that keeps premiums at a reasonable level is not easy, especially when you have to obtain the approval of people who do not think the current law should be repealed in the first place.

[Isaac:] How will the changes you’ve been talking about affect Utah’s value strategy?

[Hailey:] Value in health care is here to stay. Although Republicans and Democrats may disagree on how to get there, I think most folks agree that we need to continue to transform the U.S. health care system to one that is focused on quality and value. The economic underpinnings of this push, such as rising health care costs as a share of GDP, will continue to be a serious driver of health care reform. We’re very well-situated to be a national leader in value.

[Isaac:] How will other programs important to our work here be impacted? I’m thinking about Graduate Medical Education and research funding.

[Hailey:] In terms of GME, the good news for academic medical centers like ours is that HHS Secretary Tom Price is no stranger to GME and the funding challenges we face as we train the next generation of physicians. He’s an orthopaedic surgeon and was assistant professor of medicine at Emory, so he is well-versed in these issues. In the past, Price has shown support for increasing funding for GME, as well as the number of Medicare-supported residency spots.

[Isaac:] And research?

[Hailey:] President Trump has said little about medical research, so we don’t know much about what specific policies he may pursue there. Secretary Price has also said little about medical research funding, but he reportedly supports increasing funding as long as it is budget neutral. That means he would likely support an increase in research funding only if that funding is offset by a cut in federal funding elsewhere. Unfortunately, those offsets could come from other important health care funding streams.

One interesting development is that President Trump has reportedly sought advice from former House Speaker Newt Gingrich. Gingrich has been a longtime supporter of medical research and has even called on Congress to double the NIH budget.

Contributor Interview: Isaac Holyoak, communications administrator for University of Utah's medical group, interviewed Hailey Bandy, associate general council in the office of the general council, on February 2, 2017.