American healthcare went on a roller-coaster ride in 2017. It was a year marked by tremendous change, potential disruption and stunted progress, with familiar headlines running alongside startling new revelations.
President Trump declared the nation’s opioid epidemic a “public health emergency” in October, two months after a top pharmaceutical CEO stepped down from the president’s American Manufacturing Council. A rash of shootings sparked renewed debate about mental health reform while, across the pond, a British-born infant with a rare genetic disease was placed in the center of a heated debate about parents’ rights.
One could make a solid case for any of these stories, or dozens of others, as the top healthcare headline of the year. The following three were selected for their social, political and business impact in 2017, and for their potential to drive important healthcare changes in the future.
Merger Mania Goes Vertical
The year began with the impending merger of several large U.S. health plans. The “big five” – covering an estimated 90% of all commercially insured Americans – entered 2017 with the potential to become the even-bigger three.
Anthem was poised to acquire Cigna. Aetna, meanwhile, was on track to take over Humana. With purchase deals in place, all that remained was regulatory approval from Department of Justice (DOJ).
This particular hurdle, however, proved too tall for insurers. Citing the risk of “drastically constricting competition” in a number of key markets, then-Attorney General Loretta Lynch sued all four merger hopefuls in 2016. The insurers’ underlying merger strategy, the DOJ argued, was a clear attempt to increase market power. The courts upheld that view.
By May, both deals were dead. Aetna and Anthem were on the hook for billions of dollars in financial penalties and additional damages. Come summertime, merger mania appeared to be yesterday’s news.
However, talks of new mega-deals emerged early this month. This time, vertical (not horizontal) integration took center stage, led by pharmacy giant CVS, which proposed the $69 billion purchase of the nation’s No. 3 health insurer Aetna.
CVS officials claim the buyout will lead to cheaper drug prices for consumers, along with greater operational efficiencies for the business. Experts note the deal could also disintermediate major parts of the delivery system, drawing patients out of local emergency rooms and into CVS’s lower-priced retail clinics, especially during times when most doctors’ offices are closed.
UnitedHealth Group, the nation’s largest insurer, announced its second multi-billion dollar acquisition of the year in December. After buying Surgical Care Affiliates for about $2.3 billion in March, United recently entered into a $5 billion agreement to acquire DaVita’s primary and urgent care network. The latest move would give United more control over the care-delivery process, especially among DaVita’s 1.7 million members.
Merger rumors swirled once again this month with talks of Walmart possibly purchasing Humana, eyeing access to the insurer’s extensive Medicare Advantage membership. And although not a healthcare company yet, Amazon’s acquisition of Whole Foods may be the online retailer’s first big step toward a play in the pharmacy space.
Despite Trump’s executive order in October declaring, “My administration will … continue to focus on promoting competition in healthcare markets and limiting excessive consolidation throughout the healthcare system,” most prognosticators are betting the more vertically oriented deals will go through, with only slight concessions required from these industry giants.
Political Intrigue Rises From The Ashes
The Republican party entered 2017 with control of the U.S. House, Senate and presidency – marking the first majority sweep by either party since 2009-2010, the same era that ushered in President Obama’s signature healthcare legislation.
With the shock of the 2016 presidential election dominating headlines early in the year, Trump looked to make good on campaign promises by urging Congress to repeal and replace the Affordable Care Act.
In May, the House narrowly passed The American Health Care Act of 2017, despite estimates from the Congressional Budget Office (CBO) that 23 million Americans would lose their health insurance within a decade.
As the debate moved to the Senate floor in June, many elected officials who campaigned against the ACA learned a difficult lesson. That is, it’s easy to engage voters on Obamacare’s failings but hard to sell them on legislation that takes their health coverage away.
Without a meaningful “replacement” plan, the GOP’s attempts to undo Obamacare stalled out in the wee hours of July 28 when Republican Senator John McCain delivered a decisive thumbs-down vote.
Having failed three times to pass a bill in Congress, most people and pundits assumed federal healthcare reform would need to wait until 2018.
But like the phoenix rising from the ashes, the GOP tax plan was brought to vote in December, passing by a narrow margin in the Senate. The bill included a provision to repeal the “individual mandate,” the law requiring individuals to have an ACA-compliant insurance plan or pay a financial penalty.
Although nearly two-thirds of American voters opposed the tax plan, Republicans moved quickly to push the bill through conference committee. Having lost a Senate seat in the reliably red state of Alabama last week, the GOP found itself with an even slimmer margin for error. Rather than letting the process drag on into January, when Democrat Doug Jones is expected to be sworn in as Alabama’s newest U.S. Senator, the bill is expected to reach the president’s desk for signature as early as this week.
By eliminating the individual mandate, the CBO estimates that 13 million Americans will lose their health coverage, thus saving the federal government $338 billion over the next decade. Only time will tell if either projection proves accurate.
Sexual Misconduct Exposed
In 2017, the Silence Breakers were named TIME Magazine’s “Person of the Year” for their willingness to shine a light on a problem long kept hidden in the shadows.
Fueled by actors Rose McGowan and Ashley Judd, who came forward with allegations of sexual assault and harassment against Harvey Weinstein, the #metoo movement gained nationwide attention.
Other disturbing reports surfaced throughout 2017, detailing the exploitation of power by politicians, businessmen, media members and cultural icons. Each new revelation required courage from the individuals who stepped forward, many of whom faced threats of threats of retaliation and legal action.
Bringing these stories into the public domain has proven important for many reasons. Among them are the health consequences of this type of harassment and abuse. The link between interpersonal abuse and public health has been well validated.
Victims of sexual assault, as well as those who suffer intimate partner violence (IPV) and adverse childhood events (ACEs), frequently experience severe anxiety, depression and chronic illness. What’s more, health issues resulting from trauma are known to negatively impact not just the victims, but often their children and grandchildren, as well. Complicating matters further is that people who suffer abuse rarely get the treatment they need, often due to feelings of shame, fear or self-blame.
Although the disclosure and public acknowledgement of abuse cannot fully reverse the harm inflicted on the victims, removing the stigma of speaking out can encourage more people to step forward and, importantly, seek help. Ultimately, by providing assistance to those impacted, we can help prevent future abuses and improve the overall health of our nation.
We should expect more revelations to surface in 2018.
Do you agree or disagree with these selections for the year’s biggest healthcare stories? Share your thoughts and vote for the top healthcare story of 2017 in my latest Twitter poll.