Healthcare Management and Safety of the Affordable Care Act

After the care providers made significant changes in operations, funding, and organization to accommodate the Affordable Care Act, the prospect of it all being upended was more than disturbing. The fallout could be difficult and financially debilitating.

When the House could not muster enough votes in support of long planned repeal-and-replace legislation, it might have seemed that everyone could go back to business as usual. But, for executives and managers in the healthcare and insurance industries, that is not the case. There are many actions opponents of the ACA can still take and continued attempts to change the legislation could still result in a need for major redesigns of approaches to treatment and payment.

Continued repeal-and-replace attempts

The initial legislative overhaul attempt fell short because many moderates found proposed changes went too far and conservatives said they didn’t go far enough. That was then; this is now. Political calculus can change in a twinkling if someone finds a negotiation strategy that might gain a combination of support from enough quarters to be effective. Even if that doesn’t happen today, mid-term elections are slated for 2018. Keeping a close eye on developments and their implications, whether ultimately successful or not, will be necessary to maintain a flexible and responsive strategy.

Administrative choices

Even without repeal, the Department of Health and Human Services administers the ACA and that agency is headed by doctor and former senator Tom Price, who has been an outspoken opponent of the legislation from the beginning. Administrative choices and actions, all within the scope of legal authority, could hobble and undermine the intent of the ACA. For example, as some have suggested, a lack of marketing and promotion after the new administration was installed may have undercut enrollment. Also, the law is hardly without flaws that need to be addressed but which may not be by those in charge. Provider organizations should maintain work-around tactics as possible to deal with problems.


Even if Congress cannot muster the votes for wholesale change, there is the potential of making enough financial changes in the process called reconciliation to weaken or eliminate some critical support. That could include reducing or eliminating subsidies to allow lower- and middle-income people to purchase insurance.

Insurance carrier reactions

Some major insurers have pulled out of some exchanges because they felt the costs of coverage far exceeded the benefits. Changes, whether through legislation or administrative act, to the law will have an impact on insurers, which will respond in kind. The indirect actions could be among the most significant and require close coordination between providers and payers to offset any challenges to the system as a whole.

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