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How to adapt to any possible change in ACA

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Healthcare policy is destined for change following the election of Donald Trump and continued Republican Party control of the Senate and the House. While the exact nature of those changes remain to be seen, one thing is certain—the Affordable Care Act (ACA) will get a major overhaul.

Repeal of the Affordable Care Act (ACA) has been at the core of the Trump healthcare agenda. Trump’s website, which stated pre-election that his intention on Day One would be to “…..ask Congress to immediately deliver a full repeal of Obamacare” has been softened to “Either Obamacare will be amended or repealed and replaced.” The “repeal and replace” message also has been echoed by some Republicans. There are rumblings that Congressional Republicans may move for a budget reconciliation bill, which can be used by the Senate to pass significant revenue and spending measures. However, budget rules limit the ability to fully repeal the ACA through this mechanism.

The ACA is far reaching and impacts much more than that what most Americans think of as Obamacare. It has become an ingrained part of our healthcare system and is unlikely to go away in its entirety. Approximately 20 million individuals have health insurance coverage because of the exchanges, Medicaid expansion, the revenue provisions and delivery reforms that have been implemented during the past six years.

Since the election, the incoming administration’s healthcare agenda has started to resemble the Republican agenda that has existed for many years. One tangible indicator includes the nomination of Tom Price as head of the Department of Health and Human Services. Price has been vocal in his opposition of Obamacare, and is one of the primary architects of legislation to repeal and replace Obamacare.

Given all the unknowns, here is what we do know:

  • The new administration has indicated that certain provisions of the ACA may remain unchanged, including the pre-existing coverage and continuation of coverage for dependent children to age 26.
  • While there have been attempts to repeal and replace ACA over the past few years, replacing ACA is complex because it would need to address a large and varied number of existing insurance reforms, delivery reforms, and revenue provisions included in ACA and most critically, impact the millions of individuals who now have coverage because of these reforms.
  • Changes in leadership at HHS and policy direction change, even without implementation, will result in workforce disruption and may slow operations at the close of open enrollment and delay implementations planned for early 2017.
  • At the state level, the use of waivers, previously allowed in very limited circumstances, may increase. Waivers enable states to loosen some ACA requirements if they can provide similar coverage under their own proposal.

As a result, changes to the ACA will have many moving parts, involve powerful constituencies and have enormous budgetary implications that will likely require a deliberative process, one that follows legislative rules.

Based on both the known and the unknown, what can healthcare organizations do to anticipate these challenges? To begin, organizations should focus on:

Process. Assess organizational effectiveness that will enable you to respond to the changing healthcare marketplace. Develop or update your roadmap and design flexibility into building blocks that that will lead to successful execution and the breakthroughs that will differentiate you from your competition regardless of policy changes.

People. Use customized data and actionable takeaways to make your culture work. Increase employee engagement to facilitate alignment around your cultural tenets and support sound decision making. Address the aspects of your culture that need to adjust to meet the demands of strategic changes in healthcare. You will pivot with more agility when you have strong knowledge of your cultural landscape.

Technology. Conduct an IT maturity assessment to understand your current state, and map it to strategy to ensure gaps are addressed. Evaluate trends and determine the right time for investing and developing a plan. Design and implement a practical, scalable healthcare data and analytics ecosystem for clinical and business insight.
The impact of ACA and its six-year implementation have made ACA an integral part of the healthcare system. While changes to core components will impact the healthcare marketplace, organizations can be proactive by enhancing strengths and identifying the gaps that require attention throughout the organization to help lay the groundwork for the next set of challenges facing the constantly evolving healthcare industry.

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