December 5, 2016

Impact of the Trump Administration on Medicare and Medicaid

By
Editor’s Note: With President-Elect Donald Trump nominating U.S. Rep. Tom Price (R-Ga.) to head the U.S. Department of Health and Human Services (HHS) and Indiana’s Seema Verma to serve as administrator of the Centers for Medicare & Medicaid Services (CMS), ICD10monitor Publisher Chuck Buck recently conducted an interview with Stanley Nachimson, former HHS career federal employee, to assess the potential effect their policies might have if they are confirmed by the Senate. Price is a five-term congressman and chairman of the House Budget Committee, and also the author of the Empowering Patients First Act, a plan to repeal and replace the Patient Protection and Affordable Care Act (PPACA). In 2015 he cosponsored a bill to postpone the implementation of ICD-10 and also cosponsored legislation that would have allowed ICD-9 to be used during the nation’s transition to ICD-10. Verma, a resident of Indiana, is president, CEO, and founder of SVC Inc., a national health policy consulting company with close ties to Vice President-Elect and outgoing Indiana Governor Mike Pence. Verma is credited with being the architect of the Healthy Indiana Plan (HIP), considered to be the nation’s first consumer-directed Medicaid program for able-bodied adults.

Excerpts from that interview follow:

The selection of Rep. Tom Price (R-Ga.) to head the HHS and Seema Verma as the CMS Administrator, does that foretell that President-Elect Donald Trump might be backing down on his campaign promise not to cut Medicare and Medicaid?

I don’t think so. Ms. Verma was instrumental in Medicaid reform and expansion in Indiana; Rep. Price has strong opinions on how Medicare should be operated; but neither has expressed strong opinions on cutting the program. What many Republicans and others are concerned about is restructuring the programs to slow growth in costs and to provide more individual choice and responsibility. Both have very detailed policy backgrounds and are quite familiar with the programs.

Rep. Price has tried in successive sessions of Congress to repeal and replace “Obamacare” with his Empowering Patients First Act. What are his chances of doing so if he is confirmed by the Senate?

I would venture that Obamacare will be dismantled step by step and replaced with something that is more acceptable to Republicans and some members of the public. My guess is that mandates for coverage and minimum coverage requirements will disappear. There will be some restructuring of the Medicaid expansion as well as the Medicaid program. I doubt that the entire act that Rep. Price put together will be passed, but we will see considerable changes in Obamacare.

Turning Medicaid into a block grant program has long been a position of House Speaker Paul Ryan. If Seema Verma is confirmed to head CMS, is it likely that we will see a more consumer-directed approach to Medicaid and managed care, as she’s done in Indiana and other states?

These two objectives are not mutually exclusive. My guess is that Ms. Verma will use her policy knowledge to help craft a Medicaid program acceptable to both Mr. Ryan and Mr. Trump.

Given Rep. Tom Price’s opposition to federal funding for abortion and Planned Parenthood, are women’s health issues at stake?

I doubt it. I think there are bigger issues to deal with. Abortion is always a hot button. There may be some restrictions on abortion funding or funding for Planned Parenthood, but the overall crusade for women’s health will not be destroyed.

There are media reports that a number of House Republicans are opposed to mandatory payments – Comprehensive Care for Joint Replacement and Cardiac Bundled Payment models. How likely are those to be abandoned?

I think there is a strong likelihood that they will be cut back. Some are already established in regulation, but there are some that have not yet been finalized. I believe that they will be looked at for change. 

Hear Stanley Nachimson discuss the impact of the Trump Administration on healthcare today on Talk Ten Tuesdays  10-10:30 a.m. ET.


Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Stanley Nachimson

Stanley Nachimson is principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption.   The firm serves a number of clients, including WEDI, EHNAC, the Cooperative Exchange, the Association of American Medical Colleges, and No World Borders.  Stanley is focusing on assisting health care providers and plans with their ICD-10 implementation, and is the director of the NCHICA-WEDI Timeline Initiative.  He serves on the Board of Advisors for QualEDIx Corporation.

Stanley served for over 30 years in the US Department of Health and Human Services in a variety of statistical, management, and health technology positions.  His last ten years prior to his 2007 retirement were spent in developing HIPAA policy, regulations, and implementation planning and monitoring, beginning CMS’s work on Personal Health Records, and serving as the CMS liaison with several industry organizations, including WEDI and HITSP.  He brings a wealth of experience and information regarding the use of standards and technology in the health care industry.