1. A Conversation with Bill Pierce:
Our National Health Care Debate, Why It’s Not Over
JANUARY, 2013

2. Bill Pierce
Bill Pierce is a senior vice president at APCO Worldwide. He has
over 20 years of experience in health care policy and media
relations. He specializes in providing strategic media advice and
counsel, tactical execution and representation to a wide range of
clients facing challenging circumstances as well as great
opportunity. He is also an Adjunct Professor at The Johns
Hopkins University where he teaches classes in media relations
and crisis communications.
Mr. Pierce previously served as the deputy assistant secretary for
public affairs at the Department of Health and Human Services;
as the director of public affairs for the Blue Cross and Blue Shield
Association, and; as press secretary for Congresswoman
Olympia Snowe (R-ME) and Congressman Bill Thomas (R-CA).
Before the Hill, he worked for advocacy and political
organizations. He began his career as a research analyst for the
National Republican Senatorial Committee.
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3. Trends Have Emerged That Were Not
Created By The ACA
• Drive to find a new reimbursement system to
replace fee-for-service;
• Paying for quality;
• Emphasis on team based care, such as ACOs,
medical home and community health networks;
• Increasing focus on wellness and quality of life;
o Employers are clearly looking at programs to directly
improve health of employees (Towers Watson 2010
survey).
• Continued increase on prevention efforts.
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4. These Trends Were Captured By The ACA
The ACA is designed to encourage these trends and propel
them forward:
• CMS Innovation Center which is testing ideas such as
Bundled Payments, ACOs and Value-Based Purchasing;
• But the private sector is also moving ahead particularly
with ACO-like models of care;
• Expansion of prevention benefits under the ACA;
• Codifies existing law that allows employers/worksite
wellness programs to differentiate premiums based on
certain health status factors (BMI, tobacco cessation,
cholesterol, blood pressure).
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5. What Does The Election Mean To The ACA?
Outright repeal is not an option –
• Though expect continued talk about it (Sen. Ted Cruz);
• CLASS Act was repealed as part of the “fiscal cliff” (Part I) agreement,
clearly individual provisions are negotiable.
However, with entitlement reform on the table as part of
deficit reduction, change is still possible.
The major question then becomes:
• Will the President take proactive action to improve the law? And if so,
what?
• And the big question: With health exchanges now the focus and the
measure of success of the law, does he move to delay their
implementation given the challenges to standing them up?
o Action has now moved to states and continued clash with GOP (now
shifted to Governors);
o Utah decision was a clear indication that the Administration intends
to work with states and wants states to run exchanges;
o How will GOP respond?
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6. ACA And Exchanges Are Not A Radical Idea:
Part D and FEHBP are Federal Exchanges
But They Are Different
Conventional wisdom
ACA Challenges
Complex
suggests that
exchanges may be
New to States delayed to avoid risk
that they are not
Bigger than ready or poorly
expected for Feds functioning
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7. What To Expect Beyond The Exchange
Debate
With the GOP still controlling the House, expect
multiple investigations/oversight:
• How was the money spent;
o Expect focus on PR/media campaigns.
• Overall cost of program;
• Effectiveness of the various provisions;
• Regulatory Review:
• Why not issued on time?
• What not issued?
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8. Lawsuits Will Continue and Have
Consequences
Overall strategy is to pick away at the law
Challenge Constitutionality of Challenge legality of exchange
the contraception mandate subsidy for federal exchanges
• Conservatives believe because
• Mixed results so far, several the law does not explicitly spell
injunctions have been granted out that subsides can be offered
while several have been in federal exchanges as it does
disallowed. for state exchanges, they have an
opening to topple law;
• IRS has already issued subsidy
rules;
• Oklahoma has sued, but very
unclear who has standing (i.e.
what is harm?).
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9. So What Does This Mean for Workplace
Wellness?
• As long as the overall law remains intact, and the fact,
the wellness provisions do not have a federal cost
associated with them, no impact likely in the short term;
o Especially since there is now unity among key
stakeholders: HERO, ACOEM, ACS, ADA, AHA.
• However, in the long term as health exchanges mature
and become more robust expect more people and
businesses to buy their health care there;
o The question for the wellness industry is do they want a
role in these exchanges, and?
o What impact will it have on companies who have wellness
programs?
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10. In The End, The Election Did Not End The
Health Care Debate
“This is not the end. It is not even the
beginning of the end. But it is perhaps, the
end of the beginning.”
Sir Winston Churchill
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11. Q&A