PwC's 5 takeaways for healthcare leaders from 2018 midterms

The 2018 midterm elections shifted some control back into the hands of Democrats, who flipped the House and won some governorships, which will have mixed results for the healthcare industry, according to PwC's Health Research Institute.

Informed by interviews with healthcare advisers, association executives and a survey of 1,500 consumers, PwC's HRI outlined five key takeaways for healthcare leaders after the midterms:

1. Democrats will slow, but not halt, the Trump administration's healthcare agenda at a federal level. The administration has successfully been chipping away at its campaign promises for healthcare, from expanding the use of health savings accounts to requiring more price transparency in the industry. With a Democratic majority in the House, there will be more checks on processes to dismantle the ACA at a federal level. However, providers can expect to see some progress where priorities align, such as around actions to improve the response to the opioid crisis.

2. Federal agencies will have more oversight. With Democrats in the House, federal agencies should expect to face more scrutiny and potential investigations into their actions over the past two years, which could slow work down, according to HRI. However, it expects only a modest effect on the FDA, which currently has broad bipartisan support.

3. States are the new "battleground" for healthcare. States that that flipped governorships to Democrats — Illinois, Wisconsin, Nevada, New Mexico, Maine, Michigan and Kansas — are likely to see the following: increased budget pressure from Medicaid spending, greater fortification of state ACA exchanges, reinsurance programs similar to those of Alaska and Maryland, potential state-based individual mandate penalties, more limits to association health plans and short-term insurance plans, and further Medicaid expansions. Some states also saw their attorney general seats flip between parties, which could shift outcomes in the Republican-led lawsuit to dismantle the ACA, Texas v. USA, and the Democrat-led case seeking legal affirmation of the health law, Maryland v. USA.

4. Macroeconomic health issues will persist. Thirty million Americans still lack health insurance and healthcare costs continue to grow despite changes in party power. The uninsured rate has been fairly stable so far under the Trump administration, though HRI notes that changes made by this administration mean a small increase in the number of uninsured is ahead. Rising costs and mandatory spending associated with Medicare and Medicaid will continue to limit discretionary spending, especially as tax cuts reduce federal revenue. So far neither party has been able to successfully address rising healthcare costs, according to the report.

5. Providers should focus on five policy issues in the coming year. These include increased Medicaid expansion, more restrictions on short-term and association health plans, greater attention to opioid prescribing, and the continued shift to value-based care. HRI advises providers to improve their understanding of new Medicaid populations and maintain contact with Medicaid patients to make sure they follow work requirements. They should prepare for a slight increase in patients seeking care with more limited coverage health plans, and providers should keep an eye on changing regulations around opioids. Lastly, as expected, providers should be ready to expand their participation in value-based care and risk-bearing delivery models.

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