A few years ago, I wrote about how I didn’t think that traditional organizing wasn’t politically effective anymore, and that coalitions – teaming up with stakeholders to achieve a common goal, even if you weren’t a big fan of your partners – were the way to move forward. Coalition-building makes for some strange bedfellows.
I still believe that, even as the current administration challenges every aspect of healthcare infrastructure, at both private and public levels. Could make for even stranger bedfellows.
Other than patients and caregivers, the way I think about non-government healthcare stakeholders is that they fall into five categories: hospitals and hospital systems, clinicians, purchasers (employers), payers (insurance companies), and researchers. The latter can be divided into two very different categories, pharmaceutical companies and academic researchers, so maybe it is more like six categories. Each has different, and sometimes conflicting, priorities, or at least a different hierarchy of priorities. All of us are hurting from the current administration’s actions.
Which presents an opportunity. There has never been a circumstance where all stakeholders were on the same page. None.
Until now.
There is no healthcare sector this bill leaves unharmed.
Hospitals: caps on provider taxes, which fund hospitals, and reductions in Medicaid reimbursements will increase hospital closure rates, especially in rural areas, which have been hard hit by this and staffing shortages.
Clinicians: Those same Medicaid cuts would slash funding to clinics and clinician income.
Purchasers: Funding for preventive services, covered in full by the Affordable Care Act, would drop or disappear, leaving even the healthy parts of the population at risk for diseases like COVID and RSV. This leads to increased costs for purchasers and a decline in workplace productivity.
Payers: Medicaid cuts and ACA market disruptions, which will force the loss of coverage on millions of Americans, would cause the destabilization of all sectors of the health insurance industry. Clinicians would have an increase in the number of uninsured patients, which leads to cost shifting toward insured patients to compensate.
Researchers: I’m sure if you are reading this post, you are not unaware of the cuts to federal funding of medical research, as well as the gutting of several public health agencies within the executive branch. Even if we leave out the research on public health, which helps us reach vulnerable populations with tools they need to stay healthy, that means that all the research on both drugs and diseases either halts or is greatly diminished. Progress toward treatment or even ending our biggest healthcare threats -- the big bads like cancer and Alzheimer’s, rare diseases whose treatments are expensive and not necessarily profitable for pharma, and the ones that kill us the most like diabetes and heart disease – all gone.
State governments (bonus!): with such a severe reduction in federal funding, state governments can’t just leave their citizens to die, so they will have to make up the shortfall through higher taxes, pulling from other departments like public works and education, or a combination of the two.
The “big, beautiful” budget bill that passed so easily through the House now sits in the Senate, waiting for reconciliation. This week, the Senate Parliamentarian, who, in this case, called out Medicaid cuts as not in compliance with limitations on reconciliation bills to policy directly related to the budget. The cuts she cited would limit states’ ability to collect federal Medicaid funding, which is outside of federal budget concerns.
It is a temporary reprieve. The Senate can go back and re-write those sections so they are in compliance and then move forward.
So, why don’t I see every single stakeholder, including patients and caregivers, taking a seat at one giant table to work together to fight this bill? I see messaging and lobbying from all of them –
Sorry, each of them.
There has been a lot of coverage in the media about how bad the bill is, and in the circles where I have an ear, which covers all of the stakeholders to some degree, there is action. But not together. Patients and caregivers are writing letters and visiting their representatives. Clinicians are sticking together. The insurance companies and hospitals have their own plans, as do researchers.
Can you imagine what would happen if we coordinated a simultaneous move from both the top down and the bottom up? Pharma, insurance, employers, and hospital systems could be the top down as high-dollar campaign donors and lobbying forces. Patients and caregivers could act as bottom-up grass roots organizers, with clinicians augmenting both.
That’s a lot of power leaning on people whose only purpose sometimes appears to be keeping their jobs. And after the work is done, each party could separate to their own corners again.
Until the next bill.