By PL JETER
Health policy expert Larry Jones isn't certain that much will change about the Affordable Care Act (ACA) after President Barack Obama leaves office Jan. 20, even though President-elect Donald Trump vowed to "repeal and replace" Obamacare.
"First off, the Trump Administration and Republicans will not in any way want to displace the 20 million Americans insured through healthcare.gov," said Jones, CEO of HPOF Holdings LLC, and executive director of Integrated Independent Physicians Network LLC in Orlando. He pointed out the Congressional Budget Office's estimate last month of Medicare, Medicaid, Healthcare Exchange and Children's Health Insurance Program of $15.5 trillion between 2016 and 2026. "Can you imagine? There's got to be an alternative."
Even though Jones has focused his work on health policy for nearly a quarter-century, he began his career with 17 years at the Kimberly-Clark Corporation. For nine years, he worked with Abbey Home Health Care, now called Apria, a home health DME (durable medical equipment) company. In the 1990s, he joined other investors to establish an HMO (Health Maintenance Organization). In 1998, after WellCare acquired the DME company, Brevard Professional Network physicians asked Jones to join their IPA (Independent Physician Association) as CEO, a position he held for a decade. Jones then returned to Orlando to establish HPOF Holdings LLC, an umbrella company that developed a network of nine IPAs across Florida.
Word spread about Jones' IPA successes. He was asked to manage the Clinical Alliance Network (CAN) statewide specialty pediatric IPA. Last May, George White, MD, and Mark Chaet, MD, asked Jones to manage their newly formed IP Network (Integrated Independent Physicians Network LLC), an Orlando-based IPA representing more than 1,300 multi-specialty physicians in Central Florida. Physicians Collaborative Trust MSO, which provides primary care networks for Medicare advantage plans, was also added to HPOF.
"The whole premise of everything we do involves looking out for independent physicians, giving them tools they need to compete in this new healthcare paradigm, while also preserving and protecting the independent practice of medicine," said Jones. "Everyone (discussing health policy) has a seat at the table but the independent physician."
The unexpected presidential outcome brought to question the viability of the ACA. If Secretary of State Hilary Clinton had won, she'd already said she planned to retain the ACA and hinted at possibly doubling down on various mandates.
"The initiative in moving from fee-for-service to fee-for-value has always been a bipartisan collaboration," explained Jones. "That's not going away and neither is MACRA."
Jones believes ACA changes the Trump Administration is discussing involves restructuring the subsidies and penalties regarding employees and employers, and uninsured individuals.
"An initiative President-elect Trump mentioned in his campaign was opening up borders, and allowing insurance companies to sell policies across state lines ... to add competition to the marketplace," said Jones. "Let's face it. Healthcare.gov premiums went up 25 percent Jan. 1. An individual making $40,000 a year with an $800 policy and a $5,000 deductible may as well be uninsured."
U.S. healthcare expenditures for the last 12 months reached $3.36 trillion, Jones pointed out, emphasizing that physicians garnered only 8 percent of the healthcare dollar. "We've got to change the balance of money," he insisted. "Shifting money to physicians, particularly independent physicians, lowers the overall size of the pie."
Republicans, now holding power over the Oval Office, House and Senate, tend to make quick changes, Jones observed.
"There's got to be some restraint on repealing and replacing all these policies. We've been under the ACA since March 2010," he cautioned. "Physicians and healthcare are just now beginning to respond and react and accept the movement from fee-for-service to fee-for-value. We educate, prepare and engage with our physicians about coming healthcare changes - and we don't need too much too fast."
At Jones' core, his top priority is to preserve and protect the independent practice of medicine.
"All our leadership," he said, "understands that very clearly."