7 healthcare controversies to watch for Midterms 2014

With the midterm elections less than three months away, the race is on. Voter issues this cycle range from foreign policy and war doctrine to worries over the domestic economy and arguably the biggest piece of legislation so far during President Obama’s time in office: The Patient Protection and Affordable Care Act.

While analysts predict few major upsets in the coming cycle, in which all House and one-third of Senate seats will be contested, midterm elections generally favor the Republican Party. White, older males, a group aligning mostly with the Republican Party, turn out more than other groups during midterms, while women, young people and minorities, the Democratic Party’s steadfast supporters, stay home. And, of course, there is the “midterm advantage,” the effect whereby the party without a president in office receives a lift in numbers halfway through the sitting president’s term, according to an article from Vox.

Here are some developments in the politics of healthcare to watch as the United States heads into November 2014 elections:

1. The PPACA has become a standard attack tool. The PPACA, infamously known as Obamacare, may not be such an obvious rallying point for voters anymore, but it elicits an unusual reaction. So successfully has the term “Obamacare” been used to negatively brand the healthcare law, that even as the American public overwhelmingly supports individual provisions, the law itself remains unpopular. Kaiser Family Foundation polling data from July shows a 53 percent unfavorable view of the law, the most negative rating since 2010, when Kaiser began tracking the data, while the individual provisions receive support as high as 80 percent.

This comes after Americans haven’t seen or heard much about the law lately. However, this is liable to change, as evoking the law is now a GOP candidate strategy for demonstrating distance from President Obama’s policies. A Los Angeles Times column unambiguously names the strategy through a recent article title: “The Rove rule: When all else fails, make ‘Obamacare’ a dirty word.” Importantly, while the Kaiser poll shows about two-thirds of Americans favor amending the law rather than repealing it, healthcare, apart from the Veterans Administration oversights, is second to last on a list of issues the public would like to see better addressed by the President and Congress, with women’s health in last place.

2. Birth control, Hobby Lobby and religious exception have gained another layer of complexity. Speaking of women’s health, the controversial Supreme Court decision in Burwell v. Hobby Lobby Stores extending religious protection to for-profit companies has caused more commotion. Recently, a New York Times article brought to light an unclear definition in the ruling: the “closely held corporation.” The meaning of this definition is vital, as companies who meet it will be exempt from contraception coverage, and these exclusions will also affect women’s access to other services, such as abortions.

The article alleges the federal government, including HHS and the Internal Revenue Service have been unable to come up with a definition for “closely held corporation,” instead soliciting public comments on its two proposals, the first defining the term as a company “where none of the ownership interests in the entity is publicly traded and where the entity has fewer than a specified number of shareholders or owners,” and the second defining the term as a corporation where “a specified fraction of the ownership interest is concentrated in a limited and specified number of owners.” Regardless of the definition that emerges, it is likely the fight is not yet over, and the religious exemption will remain on trial.

3. The PPACA really did reduce the number of uninsured Americans. According to a Gallup poll, the uninsured rate in the United States has decreased 4.6 percent percent between the third quarter of 2013 and the second quarter of 2014, down to 13.4 percent. States that implemented both Medicaid expansions and state exchanges showed the largest percentage drop in the number of unemployed residents, an average of 4 percent, while states with one provision or neither experienced about a 2 percent drop in the uninsured population.

Arkansas saw the biggest percentage change in its uninsured population, with a 10.1 percent drop. Other states with 5 percent or greater drop in uninsured residents include: Kentucky (8.5 percent), Delaware (7.2 percent), Washington (6.2 percent), Colorado (6.0 percent), West Virginia (5.7 percent), Oregon (5.4 percent), California (5.3 percent) and New Mexico (5.0 percent).

4. Medicaid expansions gain ground, even among Republicans and just in time for gubernatorial elections. According to the Kaiser Family Foundation, as of Aug. 28, 27 states and the District of Columbia had implemented or were going forward with Medicaid expansion, and two states, Indiana and Utah, were still debating the expansion. Twenty states were not moving forward with the expansion.

While the Medicaid expansion has been a Democratic Party issue, several Republican governors have championed it in advance of elections, Republicans governors up for election, including Tom Corbett (R-Penn.), Bill Haslam (R-Tenn.), Matt Mead (R-Wyo.) and Gary Herbert (R-Utah), have either negotiated deals, are in negotiations, or plan to negotiate deals with CMS for a 2015 Medicaid expansion in their states, according to a report from The Washington Post. Maine’s Republican governor, Paul LePage, has opposed Medicaid expansion and is behind in the polls there. If LePage is defeated, the Maine legislature plans to attempt to move forward with the expansion, according to the Post. In all, 36 governor’s chairs are up for election or re-election come November.

A sampling of major industry reports summarized in Businessweek shows hospitals and healthcare providers in states with Medicaid expansions reported better financial returns than expected in 2014 so far, in part due to the reduction in the number of self-pay patients, who often receive charity care at a loss to the provider. The change has also been reflected in hospital stock prices in relation to the S&P 500.

5. The Veterans Affairs scandal is something everyone can agree on, almost. This issue is the number one issue the public wants Congress and the President to better address, according to Kaiser Family Foundation polling. However, according to the Office of the Inspector General, reports of the deaths of tens of veterans waiting for healthcare through VA hospitals across the country can’t be confirmed. The government watchdog couldn’t attribute the deaths to wait times for care exceeding 30 days in many cases.

The VA isn’t in the clear, despite avoiding responsibility for the veterans’ deaths. The government has appropriated $16 billion to work through the very real scheduling problems, including fake reporting, secret wait lists and unacceptable wait times for care, that led to the resignation of former VA Secretary Eric Shinseki. In addition, VA Hospitals are spending large sums of money sending patients to private providers or other local hospitals while problems are sorted out.

The VA issue has been front-and-center in campaign ads running in advance of Midterm elections, according to a report from ABC tracking the ads. Both parties have used the issue to make points. While Republicans have highlighted the scandal to criticize President Obama’s administration, Democrats have taken a more targeted approach, skewering some politicians for not taking the issue seriously enough.

6. Technical challenges have given way to ideological battles. After Healthcare.gov’s disastrous rollout, resulting in the resignation of former HHS Secretary Kathleen Sebelius, Republicans criticized the Obama administration for failing to implement sign-up logistics for what they branded as a misguided failure of a law. However, Healthcare.gov is running smoothly now, and it has even had a CEO appointed, Kevin Counihan, former head of Connecticut’s health exchange.

While Counihan predicts the coming enrollment period may be as difficult as the one the first time around, at this point, all still appears well. Where the Midterm elections are concerned, finger-pointing over technical difficulties is likely a thing of the past, receding in favor of deeply ingrained ideological conflicts over the many complex facets of the healthcare law.

Leftover issues to watch could be major game-changers. According to Politico, more developments over employer mandate delays, healthcare spending (which is projected to begin a modest increase) and reporting of premiums could all be major factors in shaping the dialogue over healthcare in politics in advance of the elections. While these may not change the outcome of any elections, they could set a very different tone for the new national Congress and state legislative debates as the country heads into the unknown that is 2015.

More articles on turnarounds:
Establishing an ASC in 2014: 71 things to know
4 strategies for adapting your team to change
Cost-containment 101: 4 basic steps for ASCs

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast