While many issues and crises competed for the public’s attention in 2017, health care captured headlines throughout the year. Perhaps as a result, almost half of Americans say health care is their top concern going into 2018, according to a new Associated Press-NORC poll. Here, we look at 10 critical events in health care during the past year.
1. Republicans failed to repeal and replace the Affordable Care Act (ACA)
Republicans could barely wait for President Donald Trump to take office before they began introducing a series of bills to repeal and replace the ACA. But none made it through Congress. The debates and votes over these repeal-and-replace bills were tense. Perhaps the most dramatic moment occurred when Senator John McCain strode to the front of the Senate chamber in July and turned his thumb down to vote “no” on the Health Care Freedom Act, also known as “skinny repeal.” Even the last-ditch Graham-Cassidy bill, which could have led to 32 million people losing coverage after 2026, failed, stalling the Republican party’s seven-year campaign to derail President Barack Obama’s health law. Behavioral science tells us that it’s more painful to lose something than it is pleasurable to gain something — a theory proving true as voters are faced with the real possibility of losing their ACA benefits.
2. But they snuck the repeal agenda into the new tax law
On December 22, President Trump signed into law the Republican tax bill, the most sweeping overhaul to America’s tax code in three decades. The law’s two major health-related provisions are the effective elimination of the ACA’s individual mandate, which requires people to have health insurance or pay a penalty, and the estimated $1.45 trillion increase in the federal deficit. The individual mandate penalty repeal could result in as many as 13 million fewer Americans having health insurance, and the increase in the federal deficit means that public programs like Medicare and Medicaid could be among the first targets for future spending cuts.
3. Despite obstacles, Americans signed up for health insurance on the ACA marketplaces
Nearly 9 million people signed up for 2018 health coverage on HealthCare.gov during this year’s shortened 45-day open enrollment period. This is only 400,000 fewer people than last year when the enrollment interval was twice as long (90 days). Eleven states and Washington, D.C., run their own health insurance marketplaces, many of which are open from two to six weeks longer. The administration also made other attempts to undermine open enrollment, including slashing funding for ACA outreach and advertising from $100 million to $10 million, and reducing support for the navigator program that helps people, particularly low-income and other vulnerable Americans, enroll in health plans.
4. Congress failed to reauthorize funding for the Children’s Health Insurance Program (CHIP) and community health centers
In an astounding political failure, Congress failed in 2017 to reauthorize two vital programs that enjoy enormous bipartisan political support: the Children’s Health Insurance Program and the community health center program. CHIP covers 9 million poor children. Community health center sites care for one in 13 Americans. Though Congress provided short-term support into the new year, the lack of long-term funding creates uncertainty and confusion, and speaks to the cost of profound partisan divide in our nation’s legislature.
5. But the Senate did pass the CHRONIC Care Act to improve care for chronically ill Americans
The Senate unanimously passed legislation last fall to improve health outcomes for patients on Medicare with chronic conditions. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act expands telehealth services and a program for seniors to receive specialized care at home. It also provides greater flexibility for Medicare Advantage plans covering chronically ill seniors. Commonwealth Fund research suggests such changes are needed: Older Americans grappling with chronic illnesses were sicker and faced more financial barriers to coverage than their counterparts in 10 other developed countries.
6. Drug overdoses drove a decline in U.S. life expectancy for the second year in a row
Americans are living shorter lives. New research reported in 2017 showed that life expectancy fell by 0.1 years, to 78.6, in 2016, according to the Centers for Disease Control and Prevention. The opioid epidemic is one of the primary drivers of this alarming trend. Soaring death rates from abuse of prescription pain medicine and illicit opiates have driven up the mortality rate among working-age white Americans. More than 42,000 Americans died of opioid overdoses in 2016, a 28 percent increase over 2015.
7. But the Trump administration failed to respond with urgency to the opioid crisis
After promising to declare the opioid crisis a national emergency in August, President Trump declared it a public health emergency in October. The designation of “national” versus “public health” matters for the allocation of federal funding to address the crisis (public health gets less money). The Trump-appointed opioid commission recommended that he declare it a national emergency so that Federal Emergency Management Agency funds could have been deployed to address the crisis.
8. Natural disasters put the health care of millions at risk
Natural disasters cost the U.S. almost $400 billion in damages in 2017, as hurricanes, heat waves, and wildfires took more than a thousand lives. With the climate changing and extreme weather events occurring with greater frequency than before, Americans must brace themselves for long-term health effects. In Puerto Rico, the death toll from Hurricane Maria alone likely exceeded 1,000, and the storm exacerbated existing health disparities between the island and the mainland. In Texas, Hurricane Harvey killed 82, and also exposed people to infectious disease and post-traumatic stress disorder, among other health risks.
9. The good news? Implementation of the 21st Century Cures Act proceeds, but slowly
The 21st Century Cures Act, signed by President Obama in 2016, increases funding for biomedical innovation (including pioneering cancer and genomic research), mental health, and substance abuse treatment, and promotes consumer protections with respect to electronic health records. However, lack of funding poses a significant obstacle to the implementation of the law’s far-reaching provisions. Minimal progress on the interoperability of electronic health records, which would allow for the transfer of information across health systems and from health systems to patients, remains a barrier to empowering patients.
10. And the FDA approved two CAR T-cell therapies for cancer
The Food and Drug Administration (FDA) approved two revolutionary treatments for patients with advanced blood cancers. CAR T-cell therapy genetically modifies patients’ immune cells (T cells) so that they vigorously attack cancer. This therapy has achieved dramatic results in generating prolonged remissions — even apparent cures — in previously untreatable cancers of the blood system, like leukemias. Until recently, CAR T-cell therapies were restricted to clinical trials. But the FDA’s approval in October of two treatments, one for children with acute lymphoblastic leukemia, the other for adults with non-Hodgkin lymphoma, offers new hope to patients whose cancers have not responded to other treatments.