Alvarez & Marsal Forecasts the Potential Winners And Losers In Obamacare Repeal

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Alvarez & Marsal’s analysis discusses the possible implications of “Repeal and Replace” and what it will mean for stakeholders in the healthcare landscape

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 Obamacare and speculates implications of repealing and replacing the Affordable Care Act (ACA). 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 Peter Urbanowicz and David Gruber, Managing Directors with Alvarez & Marsal Healthcare Industry Group who offer predictions on Trumpcare and identify 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 Mr. 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, Trumpcare will need to make improvements to cost containment. In 2015, healthcare costs increased 5.8 percent, after a 5.0 percent rise in 2014; the CPI was less than 1.0 percent in both years. According to an A&M scorecard, Obamacare receives the following grades:

Increasing coverage     A
Improving access     B-
Increasing affordability     C
Containing costs     F
Managing competition     C-
Increasing clinical effectiveness     C
Improving efficiency     D
Facilitating payment reform     B
Enhancing the experience of care     D

The analysis further identifies potential “winners and losers” under Trumpcare, 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:

  • Even higher healthcare spending for the federal government
  • States who have not expanded Medicaid will not be significantly affected by the elimination of Medicaid federal subsidies
  • Value-based payment initiatives are essential to improve operational efficiency and effectiveness for post-acute care providers
  • 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.

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.

When action matters, find us at Follow A&M on LinkedIn, Twitter and Facebook.


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Sandra Sokoloff