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CW Ep. 22: Healthcare & Policy with Meredith Mills

Meredith Mills, COO of Country Meadows Retirement Communities, breaks down the importance of understanding healthcare policies in advance of the upcoming election. She provides information on the policies of President Donald Trump and presidential candidate Joe Biden.

Welcome to Bridge the Gap Contributor Wednesday. I’m Meredith Mills. 


It’s October, 2020, and it’s hard to talk about much of anything other than COVID except perhaps the approaching presidential election. And those in the senior living space are probably well aware of the various healthcare issues up for debate in our country. So in this episode, I’d like to spend some time digging a little deeper into each candidate’s plan for addressing the challenges of healthcare in the U.S., which have only been further highlighted by the pandemic healthcare crisis. 


I remember seeing a chart a few weeks ago that showed various developed countries throughout the world— Italy, France, England, of course the U.S.— who have been hit hard by the pandemic and how many of their citizens had lost health insurance coverage as a result. And I guess I shouldn’t have been surprised as I know that so many other countries offer universal health insurance coverage to their citizens, but what the chart showed was zero impact of pandemic related job loss on the insurance status of citizens in any country, other than our own. We are one of the only countries in the world where health coverage is so intimately bound to employment. And so far with more than 26 million Americans having lost their jobs due to the pandemic, this means that in the middle of the greatest health and economic crisis that we’ve seen in generations, millions of Americans have additionally found themselves disconnected from access to basic medical care. 


Interestingly, the concept of providing broader coverage and reducing the overall uninsured population of Americans was already key to the goals of the Affordable Care Act when it was passed in 2010. And candidate Joe Biden plans to expand the support of the act while President Trump hopes to dismantle and replace it. With over 20 million Americans choosing to gain healthcare insurance through the Affordable Care Act prior to this pandemic, according to Harvard Pilgrim Healthcare, this no doubt leaves a complicated landscape for Trump, as he aims to end the pandemic and revive employment and the health insurance that’s tied to it. 


In the last presidential election, 71% of Americans over the age of 65 participated and voted, according to the U.S. Census Bureau more in fact than any other age group. Older adults are also much more likely to participate in primary elections than their younger counterparts. In the 2016 presidential election, 53% of adults 65 and older voted for President Donald Trump, whose campaign promises centered on protecting Medicare and social security and lowering drug prices.


Since coming into office, much of Trump’s focus in the healthcare realm has been on drug pricing and making several attempts to repeal or weaken the Affordable Care Act. This stands in stark contrast to Biden’s promises to strengthen and build upon the act. The candidates don’t in fact, disagree on most of the areas of concern within our healthcare system, but rather defer on what should be the ultimate solution. 


In the end, any true reform of our nation’s healthcare system must address several key realities: 


Number one: Though, no one will dispute our country’s strong approach at medical specialization and innovation, the prevention management of chronic conditions has not been an overwhelming priority. 

Number two: The aging population with baby boomers representing almost a quarter of the U.S. population will not only require strong, coordinated chronic condition management, but also funding and support for long term care needs.


Number three: The shortage of qualified medical workers in almost every area of healthcare delivery due to the overall aging population of the U.S.


And number four: The staggering increases in the cost of healthcare delivery. 


So let’s first discuss what President Trump has planned for our healthcare system delivery and insurance coverage in terms of his campaign promises. President Trump’s campaign focuses on putting patients first, offering more affordable drugs and allowing people more choice in their healthcare. Of course, his overarching message of repealing Obamacare seems to get the most traction. Trump has so far succeeded in chipping away at the Affordable Care Act with his most impactful result being the removal of the individual mandate, which he has called the worst part of Obamacare. This is the mandate that caused Americans without insurance to be charged a tax penalty if they didn’t obtain health insurance from the health care exchanges.


Although President Trump has attempted to dismantle several key tenets of Obamacare through executive orders, in June of this year, his administration appealed to the U S Supreme court to request the overturn the Affordable Care Act, labeling it as unconstitutional. Trump’s own healthcare plan remained somewhat fractured in its presentation, but the messaging for the most part remains consistent with the Republican focus of creating market competition to drive down pricing and open up consumer options. 


One area of the Trump administration’s focus is on increasing what can be covered by health savings accounts so that Americans can pay for health expenditures with income that is not subject to federal tax. Also, they would like to allow individuals to use pretax dollars to purchase individual market insurance obtained outside of their employer. Additionally, Trump has already passed several executive orders, including one making it easier for small businesses to band together to offer insurance plans and another that increased the sale of short term plans that offer up to three years coverage for individuals. 


Trump has made permanent many of the policies that ease restrictions and barriers to effective telehealth appointments during the COVID crisis. And he’s also introduced several mechanisms to lower drug prices through increasing the FDA’s approval of generics and reducing barriers to enter the drug market. President Trump has additionally pushed for price transparency for the services provided by both hospitals and providers. He has tasked Congress with ending surprise billing, which occurs when emergency care is provided by out of network providers in an in-network hospital. But so far efforts haven’t gone far due to outside influence from both hospital and insurance interest groups. President Trump has also increased competition in the Medicare advantage marketplace, which is projected to lower premiums for seniors significantly while expanding choice. 


I will comment that while attempting to research the overarching strategy for Trump’s healthcare reform, even on his own website, it’s not easy to find a clear message. However, we shouldn’t miss the forest for the trees. President Trump has clearly stated his intended tactics and values through his many executive orders, and we should not be surprised to see his strategy continuing to focus on the creation of free market competition rather than government subsidized programs to form solutions to America’s healthcare challenges. 


Vice President Joe Biden stood alongside president Barack Obama when he signed the Affordable Care Act of 2010. So it’s no surprise that it’s protection and enhancement is the key to the Biden administration’s healthcare strategy. This act was the most sweeping commitment of federal and state dollars since the creation of the Medicare and Medicaid programs of 1965. And although it has not reached its full intended potential due to several components of it being pulled back by Republicans, the ACA has shared an additional 20 million Americans and begun a complete transformation of the way Medicare dollars are distributed through the Medicare Innovation Center, which I discussed in my last episode. 


Joe Biden’s website states that he will build on the Affordable Care Act by giving Americans more choice, reduce healthcare costs and make our healthcare system less complex to navigate. Biden’s plan includes the addition of a new choice: a public option health insurance plan like Medicare, but for all Americans. Interestingly, this option would also be offered free of any premiums to those who would otherwise be Medicaid eligible, but whose state did not expand Medicaid under the Affordable Care Act as able. Biden will also add a tax credit for lower and middle income Americans in order to lower the cost of healthcare purchased on the individual free markets. 


Similar to president Trump, Vice President Biden promises to end surprise billing, and to break up the large monopolistic companies who dominate the insurance market, allowing increased competition that will drive down prices. Biden also addresses the cost of prescription drugs and talks about eliminating the role that actually keeps Medicare from being able to use its enormous purchasing power to negotiate prices with drug manufacturers, which he would eliminate. He would also open up competition by allowing consumers to buy drugs from other countries, would expedite the influx of new generic drugs and also would eliminate drug companies tax break for advertisement spending. 


So I was recently reading a Reddit thread on the weirdest things about America, from the perspective of non-Americans. And I don’t think we realize this, but no other country allows the excessive advertising of prescription drugs in the way that we do. And it certainly seems like an opportunity for cost savings. 


Lastly, though, he doesn’t state what mechanism he will use to do this,  Biden states he will partner with healthcare workforce members to drive innovative solutions in order to lower costs and improve health outcomes.


So in this year, as we have in no other, we’ve seen the stress of the U.S. healthcare system and the areas needed for true reform. As our population ages, we struggle to have enough healthcare workers to provide for all areas of care and chronic disease management is seen as a big part of the solution. We should ensure that we know our options and encourage both our residents and our coworkers to make their voices heard through voting. 2020 has been truly unprecedented, as tens of millions of Americans have lost their health insurance that was previously tied to employment. The pandemic has created a budget crisis for hospitals and providers, which will likely lead to mergers acquisitions or let’s hope not, but possibly even some providers closing their doors and government run programs are at risk as states shoulder. 


The burdensome costs of this pandemic health insurance coverage and availability is more important now than ever. I was shocked to learn this year that many of my coworkers, particularly on the frontline have never even registered to vote. It doesn’t matter what you believe or who you believe, but it’s important that we encourage all Americans to make their voices heard as both healthcare providers and consumers. There’s a lot at stake, no matter who wins this election. So let’s ensure that all of us take advantage of one of the main reasons. This country is such a wonderful place to live. Let’s ensure that we, our seniors and our coworkers get out and vote. Thank you for listening to this week’s Bridge the Gap contributor Wednesday, I’m Meredith Mills, and I approve this message.

CW Ep. 22: Healthcare & Policy with Meredith Mills