A Conversation with Bill Pierce: Our National Health Care Debate, Why It’s Not Over

JANUARY, 2013

Bill Pierce

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Bill Pierce is a senior vice president at APCO Worldwide. He has over 20 years of experience in health care policy and media relations. He specializes in providing strategic media advice and counsel, tactical execution and representation to a wide range of clients facing challenging circumstances as well as great opportunity. He is also an Adjunct Professor at The Johns Hopkins University where he teaches classes in media relations and crisis communications. Mr. Pierce previously served as the deputy assistant secretary for public affairs at the Department of Health and Human Services; as the director of public affairs for the Blue Cross and Blue Shield Association, and; as press secretary for Congresswoman Olympia Snowe (R-ME) and Congressman Bill Thomas (R-CA). Before the Hill, he worked for advocacy and political organizations. He began his career as a research analyst for the National Republican Senatorial Committee.

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Trends Have Emerged That Were Not Created By The ACA

• Drive to find a new reimbursement system to replace fee-for-service;

• Paying for quality;• Emphasis on team based care, such as ACOs,

medical home and community health networks;• Increasing focus on wellness and quality of life;

o Employers are clearly looking at programs to directly improve health of employees (Towers Watson 2010 survey).

• Continued increase on prevention efforts.

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These Trends Were Captured By The ACA

The ACA is designed to encourage these trends and propel them forward:• CMS Innovation Center which is testing ideas such as

Bundled Payments, ACOs and Value-Based Purchasing;• But the private sector is also moving ahead particularly

with ACO-like models of care;• Expansion of prevention benefits under the ACA;• Codifies existing law that allows employers/worksite

wellness programs to differentiate premiums based on certain health status factors (BMI, tobacco cessation, cholesterol, blood pressure).

What Does The Election Mean To The ACA?Outright repeal is not an option –

• Though expect continued talk about it (Sen. Ted Cruz);• CLASS Act was repealed as part of the “fiscal cliff” (Part I) agreement,

clearly individual provisions are negotiable.

However, with entitlement reform on the table as part of deficit reduction, change is still possible.

The major question then becomes:• Will the President take proactive action to improve the law? And if so,

what?• And the big question: With health exchanges now the focus and the

measure of success of the law, does he move to delay their implementation given the challenges to standing them up?o Action has now moved to states and continued clash with GOP (now

shifted to Governors);o Utah decision was a clear indication that the Administration intends

to work with states and wants states to run exchanges;o How will GOP respond?

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ACA And Exchanges Are Not A Radical Idea: Part D and FEHBP are Federal Exchanges But They Are Different

AC

A C

ha

llen

ge

s Complex

New to States

Bigger than expected for Feds

Conventional wisdom suggests that

exchanges may be delayed to avoid risk

that they are not ready or poorly

functioning

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What To Expect Beyond The Exchange Debate

With the GOP still controlling the House, expect multiple investigations/oversight:

• How was the money spent;o Expect focus on PR/media campaigns.

• Overall cost of program;• Effectiveness of the various provisions;• Regulatory Review:

• Why not issued on time?• What not issued?

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Lawsuits Will Continue and Have Consequences

Challenge Constitutionality of the contraception mandate

• Mixed results so far, several injunctions have been granted while several have been disallowed.

Overall strategy is to pick away at the law

Challenge legality of exchange subsidy for federal exchanges

• Conservatives believe because the law does not explicitly spell out that subsides can be offered in federal exchanges as it does for state exchanges, they have an opening to topple law;

• IRS has already issued subsidy rules;

• Oklahoma has sued, but very unclear who has standing (i.e. what is harm?).

So What Does This Mean for Workplace Wellness?

• As long as the overall law remains intact, and the fact, the wellness provisions do not have a federal cost associated with them, no impact likely in the short term;o Especially since there is now unity among key

stakeholders: HERO, ACOEM, ACS, ADA, AHA.

• However, in the long term as health exchanges mature and become more robust expect more people and businesses to buy their health care there;o The question for the wellness industry is do they want a

role in these exchanges, and? o What impact will it have on companies who have wellness

programs?

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In The End, The Election Did Not End The Health Care Debate

“This is not the end. It is not even the beginning of the end. But it is perhaps, the end of the beginning.”

Sir Winston Churchill

Q&A