The Apixio Blog
The RISE Nashville 2017 Keynote Address: “Politics: From the Top and the Inside and Its Impact on the Healthcare Landscape”
One of the most anticipated presentations at the 2017 RISE Nashville conference was the keynote address by Howard Fineman, Global Editorial Director of The Huffington Post and an analyst for NBC News and MSNBC. A somewhat politically charged speech, it was as frank and hard-hitting as Mr Fineman is known to be. Below are our abridged notes:
The ACA’s coverage expansion has permanently changed healthcare
Regarding the ongoing debate over the potential repeal and replacement of the Affordable Care Act (ACA), Fineman articulated that efforts to repeal the ACA will be difficult because coverage expansion fundamentally changed the conversation around health insurance. He highlighted that Medicaid expansion, in particular, deepened insurance pools and brought coverage to people who had never been able to afford it before.
Fineman noted that taking insurance, in its current form, away from these people will be very difficult.
“Barack Obama and the Democrats did a pretty shrewd thing when they passed Obamacare, they put that Medicaid money out there. Not every state took it, but it’s a lot of money: 20 Billion dollars, and the formula is going down, but still, it’s a lot of money and a lot of people who are being covered who weren’t covered.”
Partisanship and Polarization Are Only Getting Worse
Fineman said that the rifts between the ideological left and right had become chasms that will be very hard to bridge.
“There is very little middle left [in American politics].”
In fact, Fineman said that polarization within the Republican party itself is starting to become a force.
“I think the Republicans are rather confused, and the Democrats are going to do nothing as far as I can tell, except stand aside and watch the Republicans sort of, well eat each other alive.”
ACA Repeal Lacks Votes and May Eventually Lack Presidential Support
Fineman put a stake in the ground and said that ACA repeal, in its current form, lacks the votes to pass.
“All the talk of taking Obamacare and ripping it up root and branch. There’s not enough votes for that.”
“I think the Republicans are starting to worry, that if they just focus on the repeal part, the politics of this are gonna change pretty rapidly.”
Moreover, Fineman expressed the opinion that since the executive branch appears less committed to set core principles, President Trump might be willing to shift on healthcare in response to public opinion.
“He’s non-ideological…whatever the market pressure is, he’ll respond.”
It’s Tough to Change Healthcare
Near the close of his keynote Fineman relayed a powerful quote from President Trump’s senior advisor Steve Bannon: ‘We didn’t come here to do small things.’
Still, Fineman said that the healthcare system is complicated, enormous, and extremely difficult to alter:
“There is no topic in American life more complex than healthcare, which takes up what? One fifth of the economy? It’s monstrously complex, but you have to understand it to change it.”