November 28, 2016

Upheaval in DC Sure to Affect Healthcare Industry

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There is no shortage of uncertainty looming in Washington, D.C. regarding how things will unfold once President-Elect Donald Trump takes office.

One of very few predictions that appear to be a safe bet, however, is that Rhonda Taller will be among the busiest people in the nation’s capital next year.

The Talk Ten Tuesdays legislative analyst, and a member of the HIMSS Business Solutions Committee, recently laid out nine stories to watch for the coming months:

  • The vote on the 21st Century Cures Act, which Kaiser Health News recently described as “one of the most-lobbied health care bills in recent history, with nearly three lobbyists working for its passage or defeat for every member on Capitol Hill.” A total of 1,455 lobbyists representing 400 companies, universities, and other organizations reportedly pushed for or against an earlier House version of the Act, according to federal disclosure forms compiled by the Center for Responsive Politics, and a compromise version was released over the holiday weekend. The bill includes funding for enhanced cancer and Alzheimer’s research and would boost funding for the National Institutes of Health to $4.8 billion, Kaiser noted, plus speed up the drug and device approval process at the Food and Drug Administration (FDA). “(We) also need to fund the federal government beyond December 9,” Taller added. “Probably a short-term (budget) extension through end of March will get passed.”
  • The prospects of a full repeal of the Patient Protection and Affordable Care Act. “This could be a challenge, as it requires 60 votes to overturn a filibuster in the Senate – something the Dems will probably do,” Taller said. “(Republicans) could do budget reconciliation, which only requires 51 votes in the Senate, but can only be used for revenues and taxes. Keep in mind 10 million individuals on exchanges get subsidies (out of 20 million insured that way).” Some other targets under reconciliation might be the individual and employer mandates, premium subsidies, and taxes on items such as medical devices, pharmaceuticals, and insurer services, Taller added.
  • The fact that a total of 31 states, more than three in five, have expanded Medicaid. “President Trump might opt for doing executive orders, too, i.e. let states opt out of PPACA-type waivers,” Taller wrote.
  • How Trump-backed legislation could affect the healthcare industry. What will become of the continued push for value-based instead of fee-for-service care? Trump has expressed interest in “telehealth, cybersecurity, precision medicine, and of course, jobs/economy,” Taller noted. “(He also) supports block grants for Medicaid and more market-driven solutions.”
  • The ultimate fate of the Center for Medicare & Medicaid Innovation (CMMI). “Also, there will be some impact on constituencies with the (PPACA) repeal, such as hospitals that took Medicare/Medicaid cuts to help with health reform/PPACA,” Taller wrote. “They assumed they would get less uninsured patients.”
  • A jaw-dropping statistic that has yet to be widely reported: the fact that Medicare, Medicaid, and Social Security account for 88 percent of growth in federal spending. For legislators genuinely interested in taming the budget and chipping away at the deficit, that’s the juiciest target they have.
  • The fate of the Medicare Access and CHIP Reauthorization Act (MACRA) “I think it will stay,” Taller said. “It passed bipartisan, with leaders in Congress expressing support for this. And in its final rule, CMS (the Centers for Medicare & Medicaid Services) showed a lot of flexibility for MDs to implement.”
  • House Speaker’s Paul Ryan’s “Better Way” plan. Critics say it would essentially privatize Medicare. Supporters say it’s one of the only feasible ways to accomplish meaningful entitlement reform.
  • Key healthcare appointees. Up for grabs still are the nominations for the heads of the FDA, CMS, and the U.S. Department of Health and Human Services.
Stay tuned to ICD10monitor.com and Talk Ten Tuesdays, its weekly Internet radio broadcast, for more from Taller and others on these topics and more, as developments occur.
Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years.