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The Keckley Report

The Two Lessons Healthcare should take from Campaign 2022

By November 14, 2022March 1st, 2023No Comments

Last week’s headlines were these:

·        Election Day became Election Week: As of this morning, Dems will maintain control of the Senate (50-49 with the December 6 GA run-off pending) and results for House control are unknown as 19 races are uncalled. Concern about “the future of democracy” joined the inflation, abortion and crime in attracting the record midterm turnout, especially among young and independent voters.

·        Tech giants Meta (Facebook), Salesforce, Twitter and Redfin announced layoffs anticipating a recession in 2023.

·        FTX, the third-largest cryptocurrency-trading platform startup once valued at $32 billion declared bankruptcy and now faces investigations or asset freezes from regulators and prosecutors around the world.

·        Credit card interest rates (APR) reached their highest level in 37 years hitting 19.04%.

·        The Bureau of Labor CPI reported inflation was up 0.4% in October and (7.7% in the last 12 months) including groceries (+12.4% in LTM).

·        Ukraine’s President declared a desire to negotiate peace with Russia.

·        President Biden traveled to Indonesia to attend the G20 Summit where global economies are the focus.

·        And Saturday and Sunday, college and pro football stadiums joined tributes to the nation’s 23 million living Vets and their departed brothers and sisters in arms.

Inside the healthcare industry, other events were also noteworthy:

·        HHS extended the pandemic public health emergency (PHE) past its January 11, 2023 deadline allowing telehealth, subsidized coverage and attention to new omicron variants to continue.

·        Several states passed health referenda: Michigan, California and Vermont voted to make abortion a right in their states, Kentucky rejected an anti-abortion constitutional amendment; Maryland and Missouri joined 19 other states, D.C. and Guam in legalizing marijuana and South Dakota became the 39th state to expand its Medicaid program.

·        The Supreme Court heard arguments in Talevski v. Health and Hospital Corp. of Marion County that could alter liability for patient safety in nursing homes.

·        The FTC said it will use a 1914 statute to expand its court challenges against” coercive, anti-competitive behavior” by companies.

·        CMS announced its plan to expand the role of bundled payments and transparency in specialist care to strengthen its value agenda.

·        Biotech Boards announced new CEO assignments as the sector recovers from volatile financial results.

The final outcome of the Campaign 2022 vote will be in suspense until after the December 6 Senate runoff in Georgia and the final tally in the 19 contested House races is known. Both Houses are consequential for healthcare lawmaking in the forthcoming 118th Congress:

·        If Democrats win the Georgia Senate seat, they’ll have power to name committee and subcommittee chairs impacting health regulation i.e., Finance, Ways and Means, HELP et al, Expansion of Medicaid, Medicare and public health funding, safeguards against insider stock trades and anti-competitive consolidation will be their focus.

·        If Republicans win 6 of the contested House races, they’ll launch investigations through their committees and subcommittees about pandemic preparedness, Veteran’s health and drug prices among many promised. Medicare funding will take center stage as the House Budget Committee targets Medicare wastefulness and inefficiency in its performance

·        And there will be moderate consensus around increased price transparency, alternative payment programs by CMS and opioid protections and little more. Major legislation impacting healthcare is unlikely though Presidential aspirants will opine to its high cost and uneven access.

Near-term, the lame duck session that starts this week will likely consider a short list of items including…

·        Relief from some elements in prior authorization requirements by payers.

·        Temporary per diem payment to address workforce shortages.

·        Delay the Statutory PAYGO sequester in 2023.

·        Continuation of the Medicare-dependent Hospital (MDH) program for smaller hospitals with a large share of Medicare patients (impacts 170 hospitals) and Medicare’s Low-Volume Hospital (LVH) designation (600 hospitals).

And items likely to be punted to the 118th Congress next year:

·        Expansion of the Federal Debt Ceiling

·        Additional pandemic relief funding for providers

·        Federal law protecting abortion rights

·        Federal incentives to pass, fund Medicaid expansion in remaining 11 states.

·        Extension of marketplace subsidies through the end of 2025.

·        Prescription drug policies included in the Inflation Reduction Act.

·        Expansion of mental health and telehealth services.

·        Additional pandemic relief funding for providers

·        Federal law protecting abortion rights

·        Federal incentives to pass, fund Medicaid expansion in remaining 11 states.

·        Passage of the Debt Ceiling expansion in advance of the 118th Congress to protect the Inflation Reduction Act and avert cuts to Medicare, Medicaid match funding.

·        Prescription drug policies included in the Inflation Reduction Act.

My take:

Important lessons for healthcare can be learned in a post-mortem of Campaign 2022 election results:

The public’s opinion (vote) on healthcare issues is defined by personal circumstances and core beliefs about a single issue. Most lack an informed view about the entire system. Healthcare must do a better job in educating citizens about our system of health and the roles of personal responsibility, commercial operations and governmental oversight.

It must do a better job in understanding consumer needs and expectations especially in younger and independent-minded users. The healthcare market is not homogenous: a one size fits all approach to service delivery, pricing, and user experiences is short-sighted. While single-issue voter blocks in healthcare matter (i.e., abortion, Medicaid expansion, drug prices, et al), they’re unlikely to advance a system of health that contributes effectively and appropriately to the future of our democracy—a key issue in Campaign 2022.

Healthcare must respond more effectively to issues of affordability and price transparency. The inflation vote in Campaign 2022 was broad-based: though food and fuel prices have garnered the lion’s share of concern, medical care is next in line. Consider: In the latest BLS report, the CPI-U rose 0.4% in October on a seasonally adjusted basis, the same as in September. Energy prices were up 1.8%, food prices were up .8% and medical care prices were up .5% after a .8% increase in September.

Unlike fuel and food, medical care prices vary widely by provider and payer. Employers and privately insured households pay 2.24 times what Medicare pays for the same services, and underlying costs are hidden by hospitals, drug companies, insurers and medical groups.

Most in healthcare opine to their concern about affordability and their voice support for price transparency.  The working age population made the difference in Campaign 2022: they’re directly impacted by the health system’s lip-service to affordability and inept actions toward price transparency. They’ll act on their frustration is subsequent elections.

Campaign 2022 exposed two fundamental flaws in US healthcare: a limited understanding of the U.S. system of health and lack of transparency in how we operate.  It’s a heads up for all of us.



Reproductive Rights, Medicaid Expansion Found Receptive Audiences Among Voters Washington Editor, MedPage Today November 9, 2022

A New Congress Will Face Pressing Healthcare Issues, Regardless of Who Is in Control MedPage Today November 9, 2022

How Different Groups Voted in the 2022 Midterm Elections

Federal Trade Commission to Expand Use of Law Against Anticompetitive Practices WSJ November 10, 2022

Fowler et al The CMS Innovation Center’s Strategy to Support Person-centered, Value-based Specialty Care  CMS November 7, 2022

Midterm elections saw second-highest young voter turnout in 30 years, study finds turnout Washington Examiner November 11, 2022

How Different Groups Voted in the 2022 Midterm Elections

AP VoteCast survey of 94,000+ voters, conducted Oct. 31 to Nov. 8: NORC