Senate healthcare bill: the healthtech community speaks out

Steven Loeb · June 28, 2017 · Short URL:

A vote on the bill has now been delayed in order to get conservative Republicans on board

There are few issues more contentious in our politics than healthcare, and for good reason. It represents literal life and death for millions of people, and they rightfully get scared when anyone tries to change it.

Right now, the Republicans in the Senate are looking to pass the Better Care Reconciliation Act, which is basically an updated version of the American Healthcare Act (AHCA) that was passed by the Republican House in May.  

The bill has, of course, become controversial, with conservative Republicans unhappy that the bill doesn't go far enough to repeal Obamacare, which essentially expanded Medicaid coverage with little regard for how to pay for it. The GOP Senate and House bills are essentially rolling back that coverage to allow for a more free-market system to bring down costs. 

In order to ensure there are enough votes, Senate leader Mitch McConnell has decided to delay a vote on the bill so he can revise parts of it.

Despite the fact that insurance premiums have skyrocketed under Obamacare, some polls show people are unhappy with the potential loss in coverage under the Senate bill. 

The Congressional Budget Office is projecting that the number of people without health insurance would increase by 22 million by 2026, with 15 million of those coming in just the next year. Despite the fact that the CBO's projections around this topic have been off the mark, it's made for seductive headlines.  

At the same time, the CBO also said that the bill would succeed in decreasing the federal deficit by $321 billion over the next decade. 

In March, when House Republicans were getting ready to vote on the AHCA, Vator reached out to investors and entrperenuers in the healthtech space to get their opinions on the bill and what it would mean. With the debate over the Better Care Reconciliation Act currently raging, we once again reached out to get their thoughts on what this will mean going forward:

Lisa Maki, co-founder and CEO of PokitDok

"The ACA wasn’t really healthcare reform, it was insurance reform. The Senate GOP bill introduces forces to push better economics and test a free market approach. No matter what gets passed, health systems are under intense pressure to reduce their cost structure. This will require fundamentally modernizing the underlying technology infrastructure and the process with which they work with insurers, banks, consumers, suppliers and other counterparties. That’s a big reason there’s tremendous interest in APIs and blockchain.”

Daniel Kraft Faculty Chair for Medicine & Neuroscience for Singularity University and the Founder and Chair of Exponential Medicine

"The AHCA shouldn’t even have the word ‘health’ in it. It would foster, and progress our reactive ‘Sickcare’ system, shifting us away from a trajectory towards more proactive preventative care (available to those with health coverage), leading to far too many folks waiting for disease to progress, (particularly without coverage) and presenting to emergency rooms with late stage disease, often far more expensive or impossible to treat.  The leading cause of bankruptcy in the US are medical bills. The rate was halved under Obamacare. AHCA would bring more financial & emotional stress and sickness to Americans."

Ian Shakil, CEO and Co-Founder of Augmedix:

"Many startups are fundamentally predicated on key aspects of the ACA. As the ACA gets potentially modified back and forth, these startups become jeopardized and the investor support for them is threatened. I know many of these entrepreneurs. The uncertainty is a huge challenge. Other startups, such as Augmedix, thrive with or without the ACA. In a sense, we are lucky. I almost see a divide emerging between the digital health startups between those that are vs. aren't affected. I'm very grateful to be in the OK-either-way camp.

I see the fundamental macro trends of moving towards value-based care, integrated care, and more patient/customer-centric care as proceeding under either political philosophy, long term. These should be the enduring north star for digital health innovation, long term. 

I have some concerns about the financial health of some health systems. The starts and stops and ups and downs might add friction to their financial foundations, and add in some uncertainty, causing them to be more choosy about which digital health innovations to pilot and scale."

Bambi Francisco, CEO of Vator

"Let's start with the fact that the ACA has failed. Why wouldn't we want to change it? I hope the Senate passes this healthcare bill as this will get us closer to actually moving toward more affordable care. Unfortunately, the Affordable Care Act, while probably initiated with good intentions, was promoted under a false narrative. This should have been called the Medicaid expansion act, since ultimately, this is what this law did: expand medicaid, while redistributing higher costs to everyone else. I'm not sure how or why this was ever viewed or considered 'affordable.'

Since Obamacare, average premiums have more than doubled for individuals and families. Now consumers have fewer choices, such as one provider in a given region. This is due to insurers pulling out since 2016, and mainly because they're not receiving the government funds that the Obama administration promised. That said, those funds were never appropriated by congress, or so a federal judge ruled last year. This is a contentious issue and if we leave Obamacare as is, this will continue to be a cloud over healthcare.

I also think it's misleading and damaging for people to say millions will lose coverage. They're citing a CBO report assuming these same people will have coverage in 10 years. The CBO has made overinflated estimates in the past, projecting 20 million enrolled in health exchanges in 2016, only to see the real number at 10 million."

David Thompson, General Counsel, VP Strategy and Chief Privacy Officer at Grand Rounds:

"While health care reform is distracting the public dialogue on health care innovation, the real progress is being made behind the scenes by the most influential player in American health care: large employers. Employers are in a prized position to tackle ineffective health care spend and to see the impact on bottom line — both in terms of hard costs and workforce productivity. They're motivated to get the highest quality health care in the hands of those otherwise least likely to have as much."

Michelle Snyder, Chief Marketing Officer and Senior Vice President at Welltok:

“A main goal of the healthcare bill is to reduce costs, which is projected to have a significant impact on Medicaid recipients. Yet a fundamental question remains unasked and unanswered: are we getting the most value out of the dollars devoted to our healthcare system? As we look at how existing Medicaid dollars are being allocated and spent, are we connecting individuals with the resources available to proactively improve health rather than reactively treat illness?   

There are whole sets of resources provided by non-government entities that are being underutilized that would greatly benefit Medicaid recipients without additional costs. Religious organizations, for-profit companies such as Whole Foods and digital health innovators, like Wildflower Health, have a more direct and sizable impact on the social determinants of an individual’s health. At Welltok, we are bridging this gap and driving healthier consumer behaviors that improve healthcare value and quality of life regardless of economic status or political affiliation, which is something we can all agree on.”

Sami Inkinen, Founder and CEO of Virta Health

"Current estimates predict that the Senate’s Obamacare replacement bill will lead to 22 million more uninsured Americans, weaken protections for pre-existing conditions, and reshape how people with diabetes and other chronic diseases get and pay for health care. While our Congressional leaders debate in Washington, tech entrepreneurs should think of this current environment as a unique opportunity: our lens for problem solving must change to offer health care solutions that are not dependent on regulatory frameworks to succeed, but instead put the needs of the patient and provider first.

If any version of the current bill passes, it is very unlikely to improve lives of those living with complex chronic diseases, such as type-2 diabetes. Our approach at Virta has been to deliver order of magnitude better outcomes (diabetes reversal) at order of magnitude lower cost and only get paid for results. It seems that everyone across the political spectrum loves the combination of better outcomes and lower costs. That’s how entrepreneurs have to approach this type of volatile regulatory environment."

Rebecca Kim, Senior Consulting Analyst at Mercer Health Innovation LABS

"There are lots of concerns that aspects of the draft bill could introduce more instability to the individual market and this could mean more cost shifting to group or employer plans, which already pay, on average, about 80% of the health care costs for their employees and dependents. But there are some significant potential wins for employers and their employees – delay of the Cadillac tax and health insurance tax, elimination of taxes on fully insured health plans, prescription drugs, and medical devices - all would reduce costs.

Most interesting to me is the draft executive order that would change IRS rules that would allow patients enrolled in high-deductible health plans to access care and prescription drugs coverage for chronic conditions before they meet their deductible. More employers have been offering high deductible health plans as a way to cut down on healthcare spending but typically see low enrollment from those who need the most care given the potential for higher out-of-pocket costs. This change would make the plans more attractive to a broader range of consumers including those with chronic conditions and ultimately enhance coverage and lower healthcare costs in aggregate."

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