The discussion was moderated by Falguni Sen, head of the GHIMC and Director and Professor of Management Systems at Fordham University. EmblemHealth and GHIMC are partners in the EmblemHealth Value Initiative, which supports research to advance a common understanding of the value of health and the development of new outcome measures.
The event at Fordham was held five days after the American Health Care Act, a bill intended to replace the Affordable Care Act (ACA), was pulled from a House floor vote on Friday, March 24. Ignagni, who in her previous role as President and CEO of America’s Health Insurance Plans worked closely with the Obama administration and congressional leadership on the development of the ACA, began the discussion by noting that, “Friday’s developments didn’t provide any certainty with respect to the path ahead. Seven years after the passage of the ACA, policymakers need to take stock of where we currently stand with the ACA and what problems still need to be addressed.”
Affordability remains a central issue for families. “Whether it’s life insurance, auto insurance or health insurance, insurers need to balance the costs of the older and the younger, the sicker and the healthier,” Ignagni explained. “The cohort of healthy young people still needs to be encouraged to come into the system.” A Transamerica Center for Health Studies survey conducted in June 2016 found that 70% of U.S. millennials consider cost to be a “very important” factor when shopping for individual and employer-sponsored health insurance. The ACA provided help to families in two important ways: by providing premium subsidies for individuals and families, and through low-income cost-sharing subsidies. “A central question right now is whether the cost-sharing subsidies will continue. Families need to know the answer to that question, as do insurers preparing their bids for market participation next year,” said Ignagni.
Medicaid will be an important component of future health care policy proposals, with significant implications for New York. “New York has been on the leading edge with respect to Medicaid payment reform. If Congress attempts to equalize federal contributions across the states through block grants or other mechanisms, there is going to be a massive formula fight,” Ignagni predicted, referring to the debates that would take place over how to allocate federal funds. “Nothing unites Democrats and Republicans in a state like a formula fight. Currently, federal payments to many red states far exceed their tax contributions. Whereas, the opposite is true for blue states. No matter what the party label, blue or red, people who come from a specific state will be lining up together on formulas to make sure that their states are not disadvantaged.”
What is the path forward for both political parties? Ignagni recommends focusing on the fundamentals. “On both sides of the political aisle, the debate has lost sight of what’s important for families. Members of Congress need to look at issues through the lens of whether they will improve circumstances for families or put more at risk.” Transparency is key, she said. “Transparency leads to informed dialogue, which leads to good policymaking. The country can’t skip the dialogue.”
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