The Political Landscape and Its Impact on Health Care Policy › ... ›...
Transcript of The Political Landscape and Its Impact on Health Care Policy › ... ›...
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ENTRENCHED SYSTEM
DISSATISFIED PUBLIC
MINIMAL INNOVATION
BROKEN NORMS, RULES (& LAWS?)
UPENDING ESTABLISHMENT
DIRECT-TO-CONSUMERS
CONTROVERSIAL LEADER
BETTER SERVICE
Welcome to the Age of Disruption
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Disruptive Agenda
Disruptive Approach
How to Best Understand Trump?Disruptor-in-Chief
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Cabinet Members’ ResumeExperienceGovernment Experience 81% 81% 91% 91% 57%Military Experience 48% 48% 32% 9% 29%
CEO 5% 14% 18% 0% 24%
PhD 19% 24% 9% 23% 0%Source: NPR analysis of Initial Cabinet officials, updated 2/16/17
Disruptive TeamHistorically Outside-the-Beltway Cabinet
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WH STAFF(First Year Turnover) PRESIDENT
CABINET-LEVEL(Changes 1st
15 Months)
34% Trump 6
17% Reagan 1
11% Clinton 1
9% Obama 0
7% G.H.W. Bush 0
6% G.W. Bush 0Source: NPR analysis of Initial Cabinet officials, updated 2/16/17
Disruptive OperationHistorically-High Churn
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963 Days Remaining
Disruption Will ContinueWe Are 34% Into Trump’s First Term
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1982
Most Liberal Republican Most Conservative DemocratIdeological Gap in the House
GOP CaucusDEM Caucus 344 Members
1994
DEM Caucus GOP Caucus252 Members
2002
DEM Caucus GOP Caucus
137 Members
RSC (Conservatives)
2012 GOP CaucusDEM Caucus 13 Members
Source: National Journal analysis of voting records, 2013.
DEM Caucus GOP Caucus2013
4 Members
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The “Middle” Has Disappeared
8Sources: Gallup; 2016 Exit Poll
Voters Demand Change5 of Last 6 were Wave Elections
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How Did We Get Here?
Sources: Census, Pew, CDC ChildTrends, US Dept. of Labor, T. Pikety
Pace of Technology Accelerating
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11Sources: Census, Pew, World Bank (Trade);
1967 2017 CHANGEMANUFACTURING
(as a share of the U.S. workforce)27% 8.5% ▼68.5%
TRADE(as a share of U.S. GDP)
9.7% 26.6% ▲174%
FOREIGN-BORN(as a share of the U.S. population)
4.9% 14% ▲186%
WHITE NO COLLEGE(as a share of the U.S. population)
75% 39% ▼48%
ECO
NOM
YSO
CIET
Y
The Pace of Change Accelerating
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Most People Feel They Can’t Keep Up
40%Staying even with cost of living
49%Falling behind
9%Going up faster
Loss of “Honest Brokers”
Informs
Great Deal / Fair Amount of Trust in Media
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52
46 47
39
4944
31 3133
27
3632
38
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33
2732
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53 53 55
5352 52 53
44
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41 41 39 39 38
3137 38
3330
6459 61
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5970
6660 58 59
56 58 6054 55
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50
60
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1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Republicans Independents Democrats
Affirms1972 Most Trusted Man in
America
Source: Gallup13
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Medical System Banks Church /
Org. ReligionPublic
chools
1977 80% 60% 64% 53%
2017 37% 32% 41% 36%
WALL STREET
CONGRESSPOLICE
THE CHURCH
HOLLYWOOD
MEDICAL ESTABLISHMENTGreat Deal/Fair Amount of Trust in…
Lost Faith in Institutions
Read My Lips…I did not have…“…we will be greeted
as liberators...”
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Politicians are Not Trusted
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“Would you be displeased if your child married outside your political party?”
19605% Rs4% Ds
201049% Rs33% Ds
We Live in Different Worlds
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Both Sides Think They’re Winning, Plan to Double-Down
Where Do We Go From Here?
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22:1 deregulatory to regulatory actions
ANWR, Keystone & EPA reversing Obama
climate policy
Gorsuch & 12 circuit court judges appointed, most in
U.S. history
WINNINGIndividual Mandate Penalty
98% territory taken back from ISIS
70% drop in illegal border crossing (CBP)
34.8% DJIA since 2016 election
Trump Sees Significant Accomplishments
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90 9086 87
85 84 84
7977
73
63
50
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80
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Bush-43 Obama Bush-41 Trump Reagan Kennedy Johnson Nixon Clinton Carter Ford
Winning: Party Support Remains HighPresidential Approval by Own Party, ~Day 357
Source: Gallup
Opponents See Anti-Trump Tide Rising
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41 4140
39
42
4948
46
35
37
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12/7-11/16 3/1-5/17 7/5-9/17 11/2-8/17
GOP + Leaners
DEM + Leaners
Trump Remains Historically Unpopular OverallDecember of the first year of presidency
Voters More Eager to Identify as DEM, Not GOP
Source: VOX graphic showing Gallup data in December of President’s 1st year Source: Gallup, Nov. 2017
Trump Lost: ObamaCare, Border Wall Hyper-Energized Base Winning Elections
Where are Trump’s “Reagan Democrats”?
56 5661
45
28
43 4149
19
31
20
8
6864
70
57
38
59 60 63
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5256
35
0
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20
30
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50
60
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80 Other Party Independents
Presidential Job Approval ~Day 170
Source: Gallup
Losing: Not Expanding The Base
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Turning to Health Care
Where Do We Stand Right Now?
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2017-2018 Health Care LegislationSome Notable Accomplishments and Fails
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GOP Repeal/Replace Debacle
Individual Mandate Repeal (part of tax reform)
3 ACA Tax Delays: Cadillac, HIT, Device
CHIP Reauthorized (10 years)
Medicare Extenders / Donut hole relief for seniors
Medicare CHRONIC Care Improvements
The Year In Review
2018 Congressional Health AgendaLots of Debate, Not Much Action
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Opioid Crisis
ACA Market Stability
Drug Pricing, 340B Program Reform, Rx Supply Chain Oversight
ACA Market Reform, Repeal/Replace
Entitlement Reforms
What Issues Will Be Debated, Discussed?
Trump Administration Health Care Priorities
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Alex Azar• Former President, Lilly USA, LLC, Eli Lilly and Company• Former Deputy Secretary and General Counsel, U.S. Department of
Health and Human Services under George W. Bush Administration
What Are Azar’s / POTUS’ Priorities?üRx Drug Affordability = Will proposals gain traction?üOpioid Epidemic = New public health authorities, researchüAffordable Health Care = ACA market deregulation (e.g., short-term
policies, association health plans)üBold Value-based Entitlement Reforms = Provider deregulation,
CMMI re-engineered, bundles, ACO’s, and MACRA
The Long ViewWhere Is Health Policy Going?
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In Age of Disruption, Parties Moving Farther Apart
Affordability, Value Based $$ ACA De-Regulation
ACA Repeal, Block grants,
Graham-CassidyEntitlement
Reform
Medicare Price Reimbursement,
Rx PricingSingle Payer,
Medicare for allAffordability, Value
Based $$ ACA Re-Regulation
Health Care Reform Continuum
10 Health Care Trends To Watch
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Influencing Policy, Being Influenced by Policy, Or Being Completely Ignored by Policymakers
1. Increasing Health Costs
2. Growing Consumer Costs
3. Rising Consumerism4. Value-Based Care
(MACRA, Bundles, ACOs)
5. Provider & Payer Consolidation
6. Genomics/Diagnostics7. Treatment Innovations8. Technology driven
change 9. New players and
disruptors10. Opioid Crisis
Increasing Costs
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Per Capita Health Spending has Grown Substantially
30Source: Kaiser Family Foundation analysis of National Health Expenditure (NHE) data from Centers for Medicare and Medicaid Services. Office of the Actuary. National Health Statistics Group.
$355
$2,843
$4,855
$9,994
Total National Health Expenditures, US $ per capita, 1970-2016
Total National Health Expenditures Per Capita
Constant 2016 Dollars
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Source: Kaiser Family Foundation analysis of National Health Expenditure (NHE) data from Centers for Medicare and Medicaid Services. Office of the Actuary. National Health Statistics Group.
6.9%
12.1%13.3%
17.7%
Health Spending Growth Has Outpaced Growth of the U.S. EconomyTotal National Health Expenditures as a percent of GDP, 1970-2016
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Growing Consumer
Costs
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Employer Premiums Growing
Average Annual Premiums for Single and Family Coverage, 1999-2017
Single Coverage
Family Coverage
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Employer Deductibles Also Growing
Percentage of Covered Workers Enrolled in a Plan with a General Annual Deductible of $2,000 or More for Single Coverage, by Firm Size, 2009-2017
All Small Firms (3-99 Workers)
All Large Firms (200+ Workers)
ALL FIRMS
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Value-Based Care
Bundled Payments, MACRA, ACOs, VBID
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Provider & Payer ConsolidationBoth Vertical & Horizontal
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Molecular Diagnostics, Immunotherapy,
AI Therapy Design
Treatment Innovations
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Health Care Disruptors
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0
5,000
10,000
15,000
20,000
25,000Synthetic Opioids other than Methadone (N=20,145)
Heroin (N=15,446)Natural and Semi-Synthetic Opioids (N=14,427)
Methadone (N=3,314)
Opi
oid
Ove
rdos
e D
eath
s
Source: CDC. Wonder Database.
More Than 53,000 Opioid Overdose Deaths Projected in 2017
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What’s Next?
41Source: Wikipedia based on Financial Times Global 500
2003GE
Microsoft
Exxon Mobil
Pfizer
Citigroup
Wal-Mart
2008Exxon Mobil
PetroChina
Wal-Mart
China Mobile
Procter & Gamble
I&C Bank of China
2013Apple
Exxon Mobil
Microsoft
Berkshire Hathaway
GE
2018Apple
Amazon
Microsoft
Tencent
Disruptive Forces AcceleratingTECHNOLOGY: Data is the New Oil (Largest Global Companies
by Market Cap)
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Senate GOP
House GOP(Competitive Seats Defended: 51 GOP, 5 DEM)
Dems Defending
26 States(10 Trump states)
GOP Defending
9 States(1 Clinton state)
DEM WAVEGeneric Ballot (D+7.5)Trump Net Approval (-13)Enthusiasm Gap (D+18) Recruiting (52% more candidates)
Sources: Cook Report (House); RCP (generic & Trump); Fox News (Enthusiasm); NYT (candidates)
Wave Election Increasingly Possible
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OTHER NATIONS
INNOVATORSNGOs
STATESExpanding, Contracting Coverage
Washington Vacuum Being Filled
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Empowerment, 2018
Everyone’s a Witness…
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2167
15001300
980843 800 794
568376 330 300 260 255
Facebook YouTube WhatsApp WeChat QQ Instagram Tumblr Q Zone Sina Weibo Twitter Baidu Tieba
LinkedIn Snapchat
(Total Global Users, Millions)
Empowerment, 2018Everyone’s a Publisher…
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Empowerment, 2018Everyone’s an Activist…
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We’ve Been Here BeforeAnger at Inequality…
…concern about recent immigration…
…accelerating innovation…
…plutocrats increasingly playing politics…
… in divided Red States & Blue States…
…in 1888!
Conclusion
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Change is coming
Economic Reforms Political ReformsSocial Reforms