While we continue to monitor Congressional efforts to repeal and replace the ACA, we are also monitoring CMS’s efforts to implement the administration’s Medicaid program goals without Congressional action. The future of the Medicaid program depends not only on the final outcome of a repeal and replace bill, but also on the Secretary Price’s and CMS Administrator Verma’s strategy and vision for the program. In two recent Letters to Governors from Secretary Price and Administrator Verma, we see how some legislative provisions from the AHCA that are still the subject of debate could be implemented despite the lack of legislative action. Continue Reading Medicaid Reform Beyond the AHCA
This week, in their “Future of the Affordable Care Act” series on our Employment Matters blog, my colleagues Alden Bianchi and Edward Lenz provided an analysis of the major provisions of the American Health Care Act (“AHCA”).
Introduced on March 6, 2017, the AHCA is the first concrete legislative proposal detailing the initial provisions designed to repeal and replace the Affordable Care Act. As Alden and Ed discuss, the bill currently is the subject of widespread media scrutiny and intense criticism. The bill is not final and will likely face numerous changes, including the last minute proposals changes of the past 48 hours. The March 6th version offers an outline of Republican priorities in the regulation of health and health care financing, which include a strong bias in favor of market-based solutions and aversion to most (but not all) government intervention in the health care markets.
Check out their full analysis on The Future of the Affordable Care Act Week 7: The American Health Care Act, here. Continue Reading Future of the Affordable Care Act and the American Health Care Act
For Health Care stakeholders, ML Strategies considers priorities that have been identified by the Trump Administration and the Republican-controlled Congress, and forecasts possible legislative and administrative actions to move their agendas along. We all know that the ACA is a target, and whether the chosen path forward is repeal and replace, or repair and rebuild, there are some key components of the law that are vital to a healthy marketplace. ML Strategies outlines some strategies and tactics we might see in the coming weeks.
In addition to ACA repeal, the Health Care Outlook also discusses key Administration appointees for HHS, CMS and FDA, as well as potential policy advisors. There are also a number of Congressional acts up for reauthorization – the “UFAs” for FDA, CHIP and Medicare outpatient therapy caps – each important in its own right, but which also creates opportunities for ‘ride-along’ policy initiatives.
Finally, ML Strategies looks to what may happen to the ACA cost-sharing reductions with the House v. Burwell litigation, and considers whether Telemedicine might provide an opportunity for this new Congress to work together, across party lines.
Most of the post-election discussion of the ACA has focused on how promises to repeal the law could impact the newly insured. But one priority area of the ACA that has received very little discussion is the federal government’s strategy to try to reign in health care costs by reducing volume and promoting quality. Complicating the push to fully repeal the ACA is the fact that key elements of the ACA’s cost control strategy have found their way into the Medicare and CHIP Reauthorization Act (MACRA) passed by Congress in 2015.
MACRA was passed on a bipartisan, bicameral basis, creating a two-track system for Medicare provider reimbursement incentive payments. On one track is the more traditional fee-for-service reimbursement structure that will be subject to payment adjustments under a consolidated quality reporting system called the Merit-Based Incentive Payment System (MIPS). The second track, which entails greater incentive payments, addresses reimbursement for providers participating in alternative payment models (APMs) like accountable care organizations (ACOs) and other demonstration programs that have been created under CMS’s Center for Medicare & Medicaid Innovation (CMMI). We discussed these changes at length in our post last month.
While the sweeping Republican election victory portends extensive changes in many areas of health care, MACRA is not likely to see extensive changes–at least not directly. Moving payment policy away from volume and towards quality was a goal for all the Congressional offices participating in the construction of MACRA. However, the implementation of MACRA could still face challenges if Congressional Republicans decide to repeal or constrain the ACA sections that give CMS the authority to operate the CMMI. Such a move would not be outside the realm of possibility; as we previously discussed, the CMMI has been a frequent target of criticism by Congressional Republicans. A full repeal of the ACA, or even limitations to the CMMI’s authority or budget, could cripple the government’s ability to operate the demonstration projects that are the cornerstones of MACRA.
Stakeholders need to engage with CMS moving forward, albeit a CMS under new management, to ensure that changes to the ACA do not have unintended consequences on MACRA’s implementation. CMS may seek to streamline the numerous payment policies that have been proposed under the current Administration. Alternatively, it is possible that CMS will be active in creating its own versions of alternative payment models. One area of potential focus for further reform might be the so-called ACO Track 2 and 3 under the Medicare Shared Savings Program (MSSP), participation in which will now make providers eligible to receive APM incentive payments. Yet CMMI to date has struggled to find the right mix of payment reform, such as requiring two-sided risk, with payment incentives to show significant MSSP savings. In either case, the provider community will be closely watching the developments related to this already complex and daunting transition.
As we look ahead to the 115th Congress, Republicans are likely to take up repeal and replacement of the Affordable Care Act. Repeal and replace is more accurately described as a transition where Republicans design a version of health care reform they will own and defend. In doing so, Republicans must consider three important factors as they look at policy. The first two, talking with insurers and avoiding coverage disruption, were discussed in our prior blogs. The third is making hard choices.
The economist Thomas Sowell is often credited with this quote “There are no solutions, only tradeoffs.” In 2009, the Democrats made tradeoffs in constructing the Affordable Care Act. Now it will be the Republicans’ turn to make tradeoffs as they move to transition away from the Affordable Care Act. Republicans will consult stakeholders and experts and will engage the Congressional Budget Office, especially around coverage and costs. Republicans will then have to make hard choices based on the information they receive.
One specific example will involve Medicaid. Will Republicans reduce the special matching rate states receive to cover those who are newly eligible under the Affordable Care Act? They are certain to be told that drastically reducing the matching rate will cost millions of Americans their Medicaid coverage. States have made the decision to cover these low-income individuals, but if the payment is reduced, it is highly likely that state budgetary pressures will force many states to make the difficult decision of reducing or eliminating coverage.
Republicans are going to receive information about the coverage and cost consequence of their policy choices. They are going to be told things they may not have expected or wanted to hear. They will then have to decide if they want to reconsider or proceed and face the consequences.
In the end, Republicans are about to be able to engage in health care policy making in a way they weren’t in 2009. Republicans want to show they have a better way (the title of the House Republican platform). Their policies will produce coverage and cost numbers. They must decide then how they will proceed. Decisions will have consequences, and they will own those consequences.
In the coming days, we’ll be continuing to cover health care reform in the 115th Congress with a focus on specific health care programs. Stay tuned!
As we look ahead to the 115th Congress, Republicans are likely to take up repeal and replacement of the Affordable Care Act. Repeal and replace is more accurately described as a transition where Republicans design a version of health care reform they will own and defend. In doing so, Republicans must consider three important factors as they look at policy. The first, talking with the insurers, was discussed in a previous post. The second is avoiding coverage disruption. As Republicans begin the process of transition, they must avoid policies that will cause severe coverage disruption.
For example, Republicans strongly oppose the individual mandate in the Affordable Care Act. The incoming Administration could order the IRS to create a number of “carve outs” for the individual mandate that would render it ineffective. While that is a policy choice, the consequence likely would be insurers exiting the marketplace. Without a mechanism to cause participation, the risk of adverse selection becomes unacceptably high—especially given the experience to date with the Affordable Care Act population.
Republicans do not want to cause millions of people to lose coverage, but, at the same time, they want to make significant changes in the policies of the Affordable Care Act. Republicans are going to have to make structured policy decisions to minimize coverage disruptions. After years of holding the Democrats responsible for their policy decisions, Republicans will now have to own the consequences of their policy decisions.
This post is the third in a series, with the first being published on Monday and the second being published on Tuesday. In the posts that follow, we will describe additional critical issues that Republicans must tackle as they transition the Affordable Care Act and the impact of the new Congress and new administration on certain hot topics in health reform.
As we look ahead to the 115th Congress, Republicans are likely to take up repeal and replacement of the Affordable Care Act. Repeal and replace is more accurately described as a transition where Republicans design a version of health care reform they will own and defend. In doing so, Republicans must consider three important factors as they look at policy, the first of which is talking to insurers. Continue Reading Transitioning the Affordable Care Act: Republicans Must Talk to Insurers
For the last six years, Republicans have talked about repeal and replacement of the Affordable Care Act. The election outcome now puts Republicans in a position of authority to take action on the Affordable Care Act. As we look ahead to the 115th Congress, it is important to move away from political rhetoric and consider what can actually be achieved as a matter of public policy. Continue Reading It’s Not Really ”Repeal and Replace”; It’s Transition
Today, our colleagues at ML Strategies released their first look at what the results of Tuesday’s election mean for health care. The client alert addresses both the lame duck session and what to expect in 2017 and beyond. Key issues areas include the future of the Affordable Care Act, MACRA, drug pricing, and FDA User Fee Act reauthorization.
In the coming days, ML Strategies will be sharing further insight into what the election means for health care and what to expect from the new administration and Congress.
Last week, the Department of Health and Human Services (“HHS”) released new materials for covered entities to use to comply with Section 1557, the nondiscrimination provision of the Affordable Care Act. Section 1557 strengthens protections for populations that have been most vulnerable to discrimination in the health care setting by stating that individuals cannot be subject to discrimination based on race, color, national origin, sex, age, or disability.