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Healthcare Reform. Again?

It’s a DC parlor game, and it has started all over again: What will the next President do in his or her first year in office? Remember, President Obama spent much of his first year re-engineering the nation’s healthcare system. It is now looking increasingly like the next President may be forced to focus on the very same thing.

The reason is simple: By some measures, the healthcare system in this country is a complete mess. Here are a few realities:

  • Costs keep rising. Last week, the Administration said the average cost of the mid-level and most popular Obamacare plan will go up an average of 22 percent next year. In at least 8 states, rates on the healthcare exchanges are expected to rise more than 30%. In Virginia alone, insurers are seeking average premium hikes as high as 37%. Phoenix? 145%. If competition was supposed to keep insurance costs for individuals in check, it hasn’t worked.
  • Insurers are leaving the exchange market. Insurers claim they are hemorrhaging cash in the exchanges, and now they are running for the exits. Aetna is reducing the number of state exchanges it will participate in from 15 this year to four next. UnitedHealthcare is scaling back from 34 states to three. Some states will only have a single carrier selling insurance, giving new meaning to the term “marketplace.”
  • Drug costs keep going up. Between 2013 and 2015, prescription prices have increased by about 20 percent. Americans are now spending nearly twice as much as people in most other industrialized nations.
  • ER use is up. Healthcare reform was intended to increase the number of people who receive primary care and avoid costly emergency room visits. Yet, according to a 2015 survey, 75% of ED docs said that emergency room volume has gone up. A third of those said it is going up greatly.
  • There will be a huge doctor and nurse shortage. By 2025, the United States may be short 90,000 physicians. The problem in nursing is even worse. According to BLS, between 2014 and 2022, there will be 1.2 million unfilled positions for registered nurses. We need more people in medical and nursing school yesterday.

For plans, hospital systems, others in healthcare, our advice is this: don’t be shackled by politics, policy and macro trends. Seize control where you can. For example, plans and provider organizations should redouble their efforts to communicate with and engage consumers, and find new ways to do it.

At a time when people are disenchanted with the US healthcare system, developing better communications and a closer relationship with consumers is more important than ever. Encouraging them stay on their meds, visit their primary care doctor (not the ER), and obtain and keep insurance is good for patient and population health, and it’s good for business.

So if you are waiting for policymakers to sort it out, don’t. Once the new administration takes office, Washington will become consumed with its other favorite parlor game—the blame game. There’s plenty of that to go around, and this may take a while.

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