The Patient Protection and Affordable Care Act (ACA) has been modified multiple times since its inception and was again under debate during the recent presidential election. While making any solid prediction about President-elect Donald Trump’s impact on health care is tenuous, there are some specific changes Trump has focused on.
Trump’s 7 Goals for Health Care Reform
Part of his platform was to repeal Obamacare before any “positive reforms can be accomplished.” Trump specifically cited seven of his goals, which are paraphrased below:
- Repeal Obamacare
- As long as the plan purchased complies with state requirements, allow health insurance to be sold across state lines
- Allow individuals to fully deduct health insurance premiums from their tax returns
- Continue use of HSAs
- Require price transparency from all health care providers
- Block-grant Medicaid to the states
- Remove barriers to entry into free market for drug providers that offer safe, reliable and cheaper products
However, health care reform is a large, complex law with interdependencies and budget implications. Additionally, there is strong bi-partisan support for several components of reform, including the elimination of pre-existing conditions as a determinant for health care insurance and allowing dependents up to age 26 to be covered on their parent’s plan.
Potential Path to Repeal
One potential path for repeal would be a repeal of the entire legislation with an immediate replacement keeping several components that have bi-partisan support. The Budget Reconciliation process is an option for this process as it only requires 51 Senate votes instead of the typical 60 votes required for legislation. There is precedent for that process being used because it is the same method that was used to pass the legislation. Because of the complexity of this process, the law and related regulation, the Parliamentarian of the U.S. Senate will play a major role in guiding what can be done and what cannot.
Possible Repeal Roadblocks
While President-Elect Trump has indicated his plan of action immediately on the topic of health care reform, what remains uncertain is if both houses of Congress will join him in the expediency with which he would like to make this change. If the legislative process does not move quickly, it could run into the mid-term elections in 2018 where all 435 House seats and 33 Senate seats are up for election. Should the Democrats gain control of the House or the Senate, the repeal process may take even longer.
Transition of Fee-for-Service to Value-Based Care is An Independent Movement
Despite the repeal plan, both Democrats and Republicans have recognized the need to lower costs, improve quality outcomes and improve the patient experience. According to Elizabeth Whitman, reporting in Modern Healthcare, a report published by Sen. Tom Daschle and former House Speaker Newt Gingrich through the Bipartisan Policy Center, included a recommendation to “advance new and innovative approaches to health insurance coverage by taking advantage of different components of the Affordable Care Act, including models tested by the CMS Innovation Center. The report broadly acknowledged the need for expanding coverage and improving the value of health care by lowering costs and improving quality.”
The CMS Innovation Center works with the Centers for Medicare & Medicaid Services to develop and test innovative health care payment and delivery service models. Since its inception, the Innovation Center has developed numerous value-based payments and service delivery programs, including the Bundled Payment Care Initiatives and the State Innovation Models. The impact of these innovative models was focused on the need to lower costs and improve the quality of health care services. Actions taken to move away from fee-for-service to value-based care are a “movement that’s happening independent of the ACA or parallel to it,” according to David Jones, an assistant professor of health law, policy and management at Boston University’s School of Public Health. Any changes to the CMS Innovation Center and related models would impact the budget in a meaningful way, thereby requiring a thoughtful and calculated approach.
We will continue to follow the legislative proposals and changes as they play out through the Trump administration. Click here to sign up to receive our up-to-date insights. To discuss any of these issues, contact Ron Present, Partner and Health Care Industry Group Leader, at 314983.1358 or firstname.lastname@example.org.