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January 18, 2017
A&M’s analysis discusses the possible implications of “Repeal and Replace” and what it will mean for stakeholders in the healthcare landscape
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New York, NY – Amidst the evolving debate surrounding healthcare re-reform under President Trump, a new analysis, “Grading Obamacare, While Speculating About Trump: Separating Fact From Fiction” by leading, global professional services firm Alvarez & Marsal (A&M) evaluates the implications of repealing the Affordable Care Act (ACA) or “Obamacare” and outlines potential replacement legislation by the Republican congress and Trump Administration.  This analysis is coupled with an A&M podcast episode that takes a deeper dive into the possibility of said new coverage plan.

The analysis is authored by David Gruber MD, and Peter Urbanowicz, Managing Directors with Alvarez & Marsal Healthcare Industry Group who offer predictions on “Trumpcare” versus “Obamacare” and identifies potential “winners and losers” within the healthcare ecosystem. It is the first of several articles that will explore the importance of addressing the root causes of rising costs and the inefficiencies of our healthcare delivery system along with implications of forthcoming federal health policy changes.

“Regardless of which sectors are ‘victorious’ in a re-imagined system, rising health expenditures represent a threat to U.S. competitiveness, aging Baby Boomers and the financial security of the middle class,” said Dr. Gruber. “A continued shift from fee-for-service (volume) to value is required for U.S. healthcare to be sustainable.” 

“Uncertainty regarding the exact structure and components of re-reform necessitates that predictions not only take into account previously advocated positions by Trump appointees and key Republican legislators, but also recognize the vast difference between campaign rhetoric and the realities of governance,” said Mr. Urbanowicz.

The article suggests that in order for a successful transition to take place, any replacement plan to the ACA will need to make improvements to cost containment. In 2015, healthcare costs increased 5.8%, after a 5.0% rise in 2014; the CPI was <1.0% in both years. According to an A&M scorecard, Obamacare receives the following grades:

Increasing coverage


Improving access


Increasing affordability


Containing costs


Managing competition


Increasing clinical effectiveness


Improving efficiency


Facilitating payment reform


Enhancing the experience of care


The analysis further identifies potential “winners and losers” under the “replacement” legislation, drawing from the implications of the re-reform predictions becoming reality. They include the federal government, states, hospitals, post-acute care providers, physicians and insurance companies to name a few. The implications include:
  • Potentially higher healthcare spending for the federal government if cost-containment efforts not pursued.  Elimination of value-based payment initiatives may curb additional improvements in health care provider operational efficiency and effectiveness
  • More flexibility to State Medicaid programs, which would be a boon to States that have not participated in Medicaid expansion under the ACA, but might adversely affect States that have expanded
  • Elimination of the employer insurance mandate for companies with more than 50 employees will be welcomed by many businesses

The full report is available for download here.

To listen to the podcast featuring Peter Urbanowicz and David Gruber MD click here.

About Alvarez & Marsal

Companies, investors and government entities around the world turn to Alvarez & Marsal (A&M) when conventional approaches are not enough to activate change and achieve results.

Privately held since 1983, A&M is a leading global professional services firm that delivers business performance improvement, turnaround management and advisory services to organizations seeking to transform operations, catapult growth and accelerate results through decisive action.  Our senior professionals are experienced operators, world-class consultants and industry veterans who leverage the firm's restructuring heritage to help leaders turn change into a strategic business asset, manage risk and unlock value at every stage.

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