Obamacare to Trumpcare transition must consider reimbursement method

St. Luke’s Health System is on a journey to be among the best in the nation when it comes to health care outcomes and to lower the total cost of care.

We are nationally recognized in regard to the former. And for seven years, we’ve worked toward the latter, while adjusting to the requirements of the Affordable Care Act.

This year, we launched our initiative in partnership with insurance companies to take full accountability for the outcomes of care and the cost of that care. We are on our way to making health care more affordable.

But with the election, a new administration and rallying cries for repealing and replacing the ACA, St. Luke’s — and our health care colleagues in Idaho and across the country — must prepare for a whole new set of rules.

We are following 22 elements that may or may not end up in “Trumpcare,” the successor to “Obamacare.”

Those interested in my analysis can find it on my blog, but in general, I believe that only four of the 22 possible elements are either somewhat or very desirable and/or likely.

St. Luke’s did not support the ACA. It was inconceivable that tens of millions of people could be added to the ranks of the insured and health care spending would decrease.

Our concern has been validated. While decreasing the uninsured rate is laudable, it doesn’t become fiscally feasible until we also address the real driver of health care spending — the fee-for-service reimbursement system.

Unfortunately, most of the discussion around Trumpcare is the same conversation we had around Obamacare — about insurance coverage, not making fundamental changes to the broken reimbursement system.

And while Obamacare did not address the true problem, it did make a dent in the uninsured rate — and shored up the state’s care expense coffers.

The uninsured rate in Idaho fell from 17.7 percent in 2010 to 11 percent in 2015, without Medicaid expansion, and 109,000 Idahoans obtained health insurance coverage as a result of the ACA.

Costs incurred through the county and state’s catastrophic health care funds dropped from $55 million in 2012 to less than $34 million in 2016. The state’s share of those costs dropped from a record-high sum of $33.9 million to just $16.6 million over that same time period.

The Catastrophic Health Fund has returned more than $40 million to the state general fund since 2012, savings resulting from having more Idahoans with significant illnesses or injuries insured.

A lot is at stake for insurers, providers, businesses, our state’s economy and the people of Idaho as we wade into Trumpcare. As a state, we literally cannot afford to lose the benefits we have seen accrue to Idaho over the past half-dozen years. At the same time, we must address problems that remained after ACA implementation.

St. Luke’s strategy does not change, no matter who is in office, but the degree of difficulty in implementing our strategy certainly is affected. Through it all, St. Luke’s physicians and employees are intent on providing the world-class care and caring that we have become known for.

This story was originally published February 20, 2017 at 11:30 PM with the headline "Obamacare to Trumpcare transition must consider reimbursement method."