The U.S. health care reform debate and the Affordable Care Act played front and center throughout 2017 headlines. Will the GOP and Trump administration back off until after the mid-term election? Are there more concerning issues to battle in 2018?

Keeping the government funded, cost share reductions under Obamacare, Children’s Health Insurance Program (CHIP), immigration, infrastructure, opioid addiction, prescription drug cost and this list does not even include the number of concerns circling world affairs.

What is important in healthcare for 2018?

Medicaid and Medicare

Time is ticking to attempt any type of reform with Medicaid and Medicare. Republicans have been very vocal about reforming the Medicaid and Medicare entitlement programs. The push to create tougher standards for eligibility, instituting premiums and even possibly having a portion of the Medicaid community purchasing coverage on exchanges are some the changes they would like to see sooner than later. The Republican Party has a small majority in the Senate and a more sizable one in the House of Representatives and come November that could all change. The 435 House seats and 1/3 of the 100 seats in the Senate will be up for reelection. They are looking for another win following the success of the Tax Bill.

Individual Mandate

Under the current Affordable Care Act (ACA) if you can afford health insurance but choose not to purchase, you may pay a fee called the individual shared responsibility payment or individual mandate penalty. Starting this year under the new Tax Cuts and Jobs Act the individual mandate will no longer be part of the ACA which eliminates the penalty starting in 2019. However, the 2010 Affordable Care Act or otherwise known as Obamacare remains the same. Almost 9 million Americans secured coverage for 2018 through the exchanges which demonstrate there is still a high demand for the ACA. Majority of the Americans who sign up through the exchange receive federal subsidies which decrease or level out the premium increases from insurers. This has provided a desirable way to maintain the cost of health insurance for close to 80% of the current ACA insured.

Cost of Prescription Drugs

Express Scripts and Caremark are the two biggest companies that handle pharmacy benefits for more than 200 million Americans. Both announced the removing of more than 80 prescription medications from their formularies at the end of 2017. While in 2017 over 45 new drugs were brought to the market that all were introduced with very high prices. Prescription drug prices continue to rise; insurance companies continue to drop coverage which equates to fewer patients getting what they need. Making it easier for generic drug options to enter the market is a much better option for the Republicans over waging a battle against big pharma. The other trend that has picked up traction is preferred cost-sharing partnerships between insurers and large pharmacies.  In 2017 Humana negotiated with Walmart and Sam’s Club to offer reduced drug cost options under a preferred cost-sharing partnership. Aetna and CVS recently announced a deal as well. The battle continues. Will the squeeze on prescription drug cost reduce the amount of new quality drugs entered in the market from the pharmaceutical companies in the U.S? Will a common ground of cost sharing be established through alternative methods keep drug cost level while still providing big pharma the incentives to continue to innovate and bring new drugs to the market? Is making it easier for generics to hit the market faster the answer?

Opioid Crisis in America

There will a great amount of attention and pressure to develop efforts tackling the overwhelming opioid crisis in 2018. Funding will be needed and Congress will have little option but to address the crisis and approve funding for programs. Every day 115 Americans are dying from overdosing on opioids.  According to The Centers for Disease Control and Prevention, the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. In 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. Each year the numbers continue to rise.

Childers’s Health Insurance Program (CHIP) Funding

CHIP is the insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. It has been deemed as a very successful program with strong bipartisan support. A recent 2018 survey of the existing research noted that the availability of CHIP coverage for children has led to improvements in access to health care and to improvements in health over both the short-run and the long-run. The program’s funding ended in September of 2017. Congress has failed to reauthorize a long-term appropriation for it but was able to pass $3 billion dollars in funding to continue CHIP through March of 2018. The money was included in the short-term spending bill to keep the federal government open. The current program covers over 9 million children. Although the majority of both Republicans and Democrats fully support funding CHIP, it remains a difference in how to pay for it.

It is safe to say the 2010 Affordable Care Act better known as Obamacare will not be going anywhere anytime soon and definitely no other changes in 2018. Should the whole Act be replaced and if so with what?

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