IN THIS ISSUE

Richard Mark Kirkner
Divided into many different pressure groups, physicians mostly can live with the ACA. But now they have MACRA, MIPS, APM, and other puzzles to figure out.
Robert Calandra
Trump’s promise to repeal and replace the ACA could cut into revenues, but so could Clinton’s proposal for a public option. Readmission rates, bundled payments, ACOs — they fly under the radar of presidential politics and may continue regardless of the election results.
Charlotte Huff
Clinton has come out against the Cadillac tax, but what will replace the revenue? If the ACA is repealed, House Republicans have proposed capping the tax exemption for health benefits as a way to curb the appetite for expensive health care benefits.
Robert Calandra
Clinton wants to expand the existing program. Trump’s signals are mixed, but the Republican platform calls for replacing entitlements with premium support to buy private health insurance.
MediMedia Research Survey
MediMedia Research survey of our readers shows that they are evenly split on the nominees, and opinions on the ACA span the favorability spectrum.
Q&A
Interview by Peter Wehrwein

Paul Starr

The ACA was health care reform that left the health care system largely intact, says Princeton sociologist Paul Starr. A Clinton presidency could mean important adjustments to the law, including addressing the omission of a public option. Trump’s proposals would, in his view, effectively end regulation of insurance, and responsible insurers should be worried about fraudulent forms of insurance entering the market.
Q&A
Interview by Peter Wehrwein

Scott Gottlieb, MD

Medicaid expansion often means a hollow benefit, says Scott Gottlieb, MD, a resident fellow at the American Enterprise Institute and a leading conservative expert on health care policy. And the exchanges are in trouble with little political support. But Gottlieb says there will be some reluctance for sweeping reform because of a “fatigue factor,” so targeting the exchanges may be the best way forward for Republicans.
Susan Ladika

Katherine Hempstead
RWJF

9 million Americans buy health insurance outside the ACA exchanges. They make too much money to be eligible for subsidies and can often get coverage with a broader network of providers.
Tomorrow’s Medicine
Thomas Morrow, MD
HeartFlow says its algorithm can reduce the need for invasive angiograms by crunching data collected by noninvasive CT angiograms.
Value-Based Care
Michael D. Dalzell
The law was supposed to give drugmakers freedom to share health care economic information about their products. Efforts to get clarity from the FDA are stepping up.