Managing Health Care through Obamacare Ups and Downs

Trying to track the fortunes of the Affordable Care Act, otherwise known as Obamacare, is like trying to keep your eye on a hummingbird as it flits, hovers, zips, and zags. As soon as things seem to settle down somewhat, there’s another shift, like delaying one part and then another. Now businesses with between 50 and 100 employees will have another year to offer health insurance coverage.

Change won’t take your organization by complete surprise and it will be prepared to adjust plans as necessary.

It’s about more than politics; it’s about the health care business. Shifts in implementation of the law will affect the demand and form of delivery for health care. That means managers in the field may need something more than an MBA in health administration. Perhaps it’s time to break out the crystal ball — or a strong minor in political science.

As of last fall, according to Gallup, there was still a strong split in support for the legislation. Roughly 50 percent of people polled said that they disapproved of the law, while 45 percent were in favor and about 6 percent with no opinion. (Rounding is the reason the percentages don’t add to 100.)

The split is heavily skewed, depending on a person’s political allegiance. Democrats approved of the law 83 percent to 15 percent against, with 2 percent having no opinion. Republicans were close to a mirror flip: roughly 86 percent disapproved, 11 percent approved, and 4 percent had no opinion. As for independents, 39 percent approved, 53 percent disapproved, and 8 percent had no opinion.

Americans under 30-years-old skewed 51 percent in favor, 44 percent against. Those between 30 and 49-years-old, it was a roughly even in favor and opposed. From 50 to 64-years-old, 41 percent approved, 54 percent disapproved. And for those 65 and older, 38 percent were in favor and 54 percent against.

This has become a political minefield. Democrats are sharply aware that in many states, the ACA is a liability for reelection, as the New York Times notes. Democratic political leaders are pushing their candidates to talk about the shortcomings of the law and implementation and then discuss their ideas of how to improve it. (Recent polls show that the public would generally prefer to fix the law than to repeal it.) Republicans are trying to turn the ACA into a referendum issue for midterm elections.

What this means for health care executives and managers is that while they have to plan for the eventual implementation of the ACA, they cannot assume that it will ultimately remain in the same form as today — or even that it will definitely exist. 

The reality puts a premium on scenario planning. Instead of creating one strategic or tactical plan, create multiple ones. A first might assume ACA implementation continues on the now current path, another might assume additional delay, and a third could look at insurance adoption in your geographic area and how that might affect demand.

Also, assume you must now support a planning process, not just a plan. As the tides shift one way or the other, update the existing plans. Change won’t take your organization by complete surprise and it will be prepared to adjust plans as necessary.