ORLANDO – In a joint appearance at HIMSS17 on Thursday, former Speaker of the House John Boehner, R-Ohio, and Democratic former Pennsylvania Gov. Ed Rendell took part in a lively back-and-forth discussion about the future of the Affordable Care Act, the value of health IT and the prospects for Donald Trump's presidency.

Moderating the chat, HIMSS CEO Steve Lieber asked the two men what each political party did right and wrong in passing the ACA in 2010.

"What they did right was offer affordable healthcare to all people, but what they did wrong is forcing people to be a part of a group that they didn’t want to belong to," said Boehner.

He criticized the fact that the legislation passed both chambers of Congress without a single Republican vote. "Big things in America that are lasting happen on a bipartisan basis," he said.

Rendell said the Democrats succeeded in extending healthcare coverage to 20 million people who didn't have it before. "But where they failed is in the affordability side of the equation," he said. "There wasn't enough emphasis on cost-cutting as there should have been."

Information technology is an essential way to do that said Rendell, who pointed to telehealth, which is deployed "throughout Pennsylvania (and is) particularly useful for small counties, many of which have lost their primary care physicians," he said. "We try to deal with that by increasing the scope of practice by nurse practitioners, and telehealth has been an enormous help in doing that."

He also touted patient-centered medical homes as a "far better and more cost-effective way to treat patients."

But as for the politics surrounding the future of the ACA, Rendell joked that the "remedy is easy: We should get rid of Obamacare, and keep the Affordable Care Act."

Semantics aside, Boehner complained that Republicans "were shut out" of the drafting of the ACA, and so felt little inclination during the Obama administration to fix it. "Our fingerprints weren't on this, so the problems weren't our problems," he said. "If they had opened the door, we would have worked with them, but would have wanted to make some changes."

That said, he conceded that Republican fingerprints will be "all over" whatever comes next for the healthcare law, which he said is a "work in progress."

Boehner warned his fellow Republicans: "If you pass repeal without replace, anything that happens is your fault. You broke it."

That's a big reason, he suspects, why "most of the ACA's framework is going to stay there: Coverage for kids up to age 26, covering those with preexisting conditions, subsidies for those who can't afford it who aren't on Medicaid. All that will be there."

"What will be different is that CMS will not dictate to every single state exactly how the plan is going to run," he said.

Boehner said he's skeptical of the "repeal-and-replace" mantra for one big reason: The "replace" part of the equation is much easier said than done.

In all his time in Congress, he said, "Republicans have never, ever, not one time agreed what a healthcare proposal should look like. Not once. They will never ever agree what the bill should be. Perfect always becomes the enemy of the good."

Health IT leads to 'better outcomes'
If the politics of the ACA are thorny and contentious, one thing that has always seemed to "never be a political question" is the value of health information technology, Lieber suggested. "A common thought is that technology was one of the ways we were going to solve some of the big problems in healthcare."

Boehner said that is "absolutely true." His GOP colleagues have always been committed to health IT because they see how it leads to "better outcomes for the American people."

Rendell said continued investment in IT is essential to attaining its full potential. "If we're going to have a true information-based healthcare system, using technology to its fullest extent, we have to pay to lay the infrastructure," he said. States and the federal government ought to participate in that. Sometimes you spend money to save money."

The rapport between the two former politicians was joking and jovial. "We're a couple of has-beens," Boehner laughed. "All we are now is celebrities."

Indeed, they now find themselves observers and commentators on an entirely new political era. Someone else is in charge.

"All the norms are gone," said Boehner. "All the bedrock principles – what you do, what you don't do – is all thrown out the window."

Now into the second month of the Donald Trump administration, it seems clear "we're in for a pretty raucous ride," he said. I think the Trump presidency is going to look a lot like the Trump campaign: Sometimes divisive, sometimes incoherent, sometimes disrespectful. But also sometimes effective."

The problem, said Rendell, is that "you can't govern the same way you campaign. You simply can't. You've got to value the institutions."

"He's going to do things that a normal politician like Ed or I wouldn't do," said Boehner. "But he's going to have an opportunity to do big things."

Lieber asked what Boehner and Rendell think will be the Trump's signature political accomplishment.

"If I had to throw a dart today? Immigration reform," said Boehner. "There’s a way to deal with this in a humane way. Four years down the road, Donald Trump may be the immigrant's best friend."

Rendell looked at him quizzically: "Are you alright?"

For his part, he suggested the easiest path to a lasting positive legacy for Trump is "inherently bipartisan and it's desperately needed. It's a big thing, and Donald Trump wants to do big things: a real infrastructure revitalization program. The American infrastructure is crumbling."

At the close of the keynote, Rendell implored the HIMSS17 crowd to continue the work of developing a robust health IT infrastructure, and leveraging it for improved outcomes.

"You all should keep doing what you're doing," he said. "Keep innovating. Keep finding ways to deliver quality care at a more affordable price tag. Eventually we're going to get it right."

This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.

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