Hamburg & McDonough Discuss Future of Health Reform

On November 28, 2016, the Solomon Center hosted Peggy Hamburg and John McDonough to discuss the future of health reform following the election. Hamburg served for six years as the FDA Commissioner. McDonough was one of the lead Senate staffers for the Affordable Care Act and the author of Inside National Health Reform, an account of that experience and the bill that came out of it.

McDonough described the Affordable Care Act (ACA) as already having survived five near-death experiences and now facing a sixth. He believes that Congress is likely to pursue a “repeal and delay” of the ACA through a reconciliation budget bill in January, meaning that they would repeal the ACA, but delay the effective date for two years or more in order to have time to develop a replacement. He recommended looking at the budget reconciliation bill that Congress passed in December 2015 (which was vetoed by President Obama) to see the dry run for the upcoming attempt. He also recommended review of Paul Ryan’s A Better Way for indications of potential replacement options under consideration. There is a lot that is still uncertain, and repeal of the ACA could place the health insurance of 20.2 million people in jeopardy.

Hamburg discussed the importance of continuing to break down some of the common prejudices about the FDA—that it is a barrier to innovation and a “black box” lacking transparency. She noted that we are currently living in the golden age of life sciences, and there is tremendous opportunity to build on developments and produce better products. However, for this to happen, she believes we need a well-resourced FDA to ensure products are safe and effective. She highlighted the importance of the agency’s commitment to scientific evidence and expressed concerns about any weakening of standards.

McDonough and Hamburg agreed that those who support some or all of the ACA need to be vocal about its successes, the potential costs of its repeal, and the substantial problems with many of the replacement mechanisms that have been proposed so far. McDonough highlighted, however, that much of the debate is about differences in values. Is heath care a right or not? He urged supporters of the ACA to look to areas of shared values when making their arguments in favor of retaining the law.