The Political Landscape and Its Impact on Health Care Policy › ... › political-impact-on-health-care-policy.pdf · Resume Experience Government Experience 81% 81% 91% 91% 57%

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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

3

Disruptive Agenda

Disruptive Approach

How to Best Understand Trump?Disruptor-in-Chief

4

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

497

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

7

The “Middle” Has Disappeared

8Sources: Gallup; 2016 Exit Poll

Voters Demand Change5 of Last 6 were Wave Elections

9

How Did We Get Here?

Sources: Census, Pew, CDC ChildTrends, US Dept. of Labor, T. Pikety

Pace of Technology Accelerating

10

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

41

52

46 47

39

4944

31 3133

27

3632

38

26

33

2732

14

53 53 55

5352 52 53

44

49

41 41 39 39 38

3137 38

3330

6459 61

53

65

59

66

5970

6660 58 59

56 58 6054 55

51

10

20

30

40

50

60

70

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

14

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...”

15

Politicians are Not Trusted

16

“Would you be displeased if your child married outside your political party?”

19605% Rs4% Ds

201049% Rs33% Ds

We Live in Different Worlds

17

Both Sides Think They’re Winning, Plan to Double-Down

Where Do We Go From Here?

18

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

19

90 9086 87

85 84 84

7977

73

63

50

55

60

65

70

75

80

85

90

95

100

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

20

41 4140

39

42

4948

46

35

37

39

41

43

45

47

49

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

41

5256

35

0

10

20

30

40

50

60

70

80 Other Party Independents

Presidential Job Approval ~Day 170

Source: Gallup

Losing: Not Expanding The Base

21

Turning to Health Care

Where Do We Stand Right Now?

22

2017-2018 Health Care LegislationSome Notable Accomplishments and Fails

23

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

32

Growing Consumer

Costs

33

Employer Premiums Growing

Average Annual Premiums for Single and Family Coverage, 1999-2017

Single Coverage

Family Coverage

34

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

35

Value-Based Care

Bundled Payments, MACRA, ACOs, VBID

36

Provider & Payer ConsolidationBoth Vertical & Horizontal

37

Molecular Diagnostics, Immunotherapy,

AI Therapy Design

Treatment Innovations

38

Health Care Disruptors

39

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

Google

Berkshire Hathaway

GE

2018Apple

Amazon

Google

Microsoft

Facebook

Tencent

Disruptive Forces AcceleratingTECHNOLOGY: Data is the New Oil (Largest Global Companies

by Market Cap)

42

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

43

OTHER NATIONS

INNOVATORSNGOs

STATESExpanding, Contracting Coverage

Washington Vacuum Being Filled

44

Empowerment, 2018

Everyone’s a Witness…

45

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…

46

Empowerment, 2018Everyone’s an Activist…

47

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