New Senate, governor, and the old health care

Four experts from Philly.com's "Field Clinic" blog shared their thoughts last week at Drexel University on the future of Obamacare - Apocalyse or Affirmation - after the Republican takeover of the Senate and the election of a Democratic governor in Pennsylvania.

Speakers were Wharton health economist Mark Pauly, former Temple Health System vice president Paula Stillman, Pennsylvania Health Access Network director Antoinette Kraus, and Drexel professor Robert Field, blog editor.

What will the congressional Republicans do? Pauly said full repeal of the Affordable Care Act is unlikely because it can be filibustered in the Senate and vetoed by the president. But the Republicans may want to reshape Obamacare and say " 'We struck a blow for freedom.' "

Both parties are skeptical of the law's medical device tax because it could deter innovation, Pauly said. Other taxes on drugs and insurers are "things the Republicans may want to pick off."

Both mandates, the one for large firms to cover full-timers and for individuals to have insurance, are vulnerable, he said. And Republicans also may want to make more middle-class people eligible for tax credits. Democrats may find it hard to oppose a proposal that would help more people afford insurance.

Pennsylvania, Wolf, and Medicaid. GOP Gov. Corbett got Healthy Pennsylvania approved, a plan that put more costs onto recipients. How will new Democratic Gov. Tom Wolf react?

Kraus thinks he will abandon the plan for a conventional Medicaid expansion, but "realistically, it can't happen overnight."

Stillman said Wolf supports more freedom of choice for women and wants Pennsylvania to develop its own exchange for Obamacare.

The insurance exchanges reopen Saturday. Is another disaster looming? Kraus said the healthcare.gov site has been working "pretty smoothly since they hammered out a lot of the glitches." The process this year will be a lot simpler, with 12 screens instead of 72, she said. There will also be lots of free help.

But she "can't say with confidence the marketplace will operate smoothly on Day 1." Most of the people who are uninsured still have no idea these plans are out there, Kraus said. So getting out the word remains a top goal.

Health care in the next election. Stillman said health care has to be an issue because "the trajectory of expenditures is not sustainable and there are many indications the quality is not that high . . . . We're going to bankrupt our Medicare system."

Pauly said "Medicare could end up a much more salient issue in 2015."

"I wrote my [Ph.D.] thesis on Medicare when I was 26," he added. "Now I'm going to have to confront it personally."

Field noted that debate on health reforms has long been highly partisan, citing Franklin Roosevelt's attempts in 1937, Johnson's creation of Medicare in 1965, Clinton's failed push in 1993, Bush's Medicare Part D prescription drug program in 2003, and Obamacare since 2009. It's "a continuation of the epic opera," he said. "We think the fat lady is going to sing and yet there is another act to go."