Joe Biden’s presidency means only one thing for the Affordable Care Act — that it will be restored and strengthened over the next four years. But to be successful, the new administration needs to learn from the lessons of 2009 when the then-controversial policy was being enshrined into law by President Barrack Obama.
That’s according to Kathleen Sebelius, who served as secretary of the Department of Health and Human Services from 2009 to 2014. On Tuesday at the all-virtual Health Datapalooza and National Health Policy Conference, Sebelius took a trip down memory lane, looking back at the early days of the passage of the ACA.
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“Looking back, one of the things I would change with a magic wand [is] if we knew we would not have Republican votes, we could have moved a lot faster and had sort of different version of the Affordable Care Act at the outset,” she said. “We tried to incorporate…ideas that we thought might bring Republican votes with them. But unfortunately, we got the ideas and not the votes.”
That’s an interesting piece of advice from the former HHS lead especially given how Biden has repeatedly said he wants to move America forward in a more unified manner. But Sebelius’ advice may be more practical.
Recall that hours were spent in committee hearings in the House to include some Republican amendments to help win their support as Obama wanted a bipartisan healthcare deal. Only it didn’t happen.
The House version of the ACA failed in the Senate, and the more conservative Senate version was taken up instead. The end result was that ACA looked very different from what the Obama administration had been hoping for, Sebelius said.
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Now, with the nomination of vocal ACA supporter Xavier Becerra as HHS secretary, the ACA is likely to be bolstered. But the big challenge for Biden and Becerra will be figuring out whether to try and build a bipartisan coalition to rebuild the framework of the ACA.
“Our lesson [learned from ’09 and ’10] was maybe that wasn’t the smartest thing to do,” Sebelius said. “Joe Biden was there. He knows what the result of that [period] was. I’m hoping they really put the gas [pedal] down.”
The new administration is already making moves to safeguard the ACA. Last week, the Justice Department sent a letter to the Supreme Court saying it no longer supports efforts undertaken by some Republican-led states to declare the ACA unconstitutional. The administration has also reopened the ACA marketplaces for a special three-month enrollment period and is talking about capping out-of-pocket costs at 8.5%, which “would be huge” for patients, Sebelius said.
Further, the CMS Innovation Center — one of the most impactful divisions created by the ACA in Sebelius’ opinion — has survived and continues to spur transformation in healthcare.
The establishment of the CMS Innovation Center allowed Medicare, Medicaid and Children’s Health Insurance plans to test payment protocols, examine new options and then select the protocol most likely to improve quality and lower costs, Sebelius said.
“That was huge,” she said. ” It still is huge. It still can drive more reforms than anything else. [The CMS Innovation Center] is a $10 billion self-funding pool that continues to exist, and I think, will drive massive changes.”
Overall, there is lots of good news and change coming in the ACA arena, Sebelius said.
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