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With GOP plan dead, future of health care reform uncertain
On Friday, March 24, Speaker of the House Paul Ryan (R-WI) cancelled a vote on the American Health Care Act (AHCA), acknowledging that the Republican replacement bill lacked enough support to pass. The AHCA would have repealed tax penalties for people without health insurance, rolled back federal insurance standards, reduced subsidies for the purchase of private insurance and set new limits on spending for Medicaid. With no alternative plan from Republicans, the Affordable Care Act (ACA) will remain in place. Robert Pear, Thomas Kaplan and Maggie Haberman of The New York Times explain.
Although efforts to repeal have not been successful, the Trump administration can use the regulatory process to change how the law is administered and enforced. The Department of Health and Human Services (HHS) has broad discretion in interpreting the ACA. HHS has already delayed the implementation of alternative payment programs for Medicare, and President Trump signed an executive order instructing departments to minimize the impact of the law, according to Reuters.
Trump, who has asserted that the ACA is on the verge of collapse, must make key regulatory decisions in preparation for 2018. Insurers have asked the Administration to continue cost-sharing subsidies, eliminate a tax on insurers and help stabilize the ACA risk pools through additional funds, notes Zachary Tracer of Bloomberg.
If Trump defends subsidies for low-income consumers in court and encourages insurance participation in the exchanges, he can potentially stabilize the marketplace. To steer the law in a more conservative direction, the Administration could reshape the Medicaid program by providing states with waivers that allow them to impose premiums and work requirements for beneficiaries, writes Margot Sanger-Katz of The New York Times.
Following Friday’s failed repeal attempt, Trump and key White House advisors have stated that they are open to working with Democrats on health care reform. While speaking to Fox News’ Chris Wallace, White House Chief of Staff Reince Priebus indicated the president was considering all available options for addressing health care reform. Priebus acknowledged Republicans may have to compromise and that a perfect bill that satisfies all GOP lawmakers was not possible, writes Mallory Shelbourne of The Hill.
Defeat of GOP health bill eases governors’ worries
Governors from both parties are relieved the Republican health care plan did not pass. Many governors were concerned about provisions in the bill that would cut Medicaid spending by shifting the program to a per capita funding structure. Governors were also worried by reports projecting 14 million people would lose insurance next year, writes The Associated Press.
CMS seeks to increase ACO participation
The Centers for Medicare and Medicaid Services is looking to encourage participation in accountable care organizations (ACO) by automating the system that matches patients with doctors. Virgil Dickson at Modern Healthcare shares that Medicare beneficiaries can visit a website that will assign them to their primary care doctor and the provider’s ACO. The current process assigns patients to ACOs retroactively. The new system will allow providers to know who is participating in ACOs sooner.
Our weekly Blog Review features insightful posts from around the web and keeps an eye on medical industry and health news via the Trend Watch. This week we review posts debating the role of pharmacy benefit managers. This week’s Trend Watch compiles posts discussing ways to structure health care programs.
Pharmacy Benefit Managers
PBMs: A Proven Partner in Keeping Prescriptions Affordable
Coalition for Affordable Prescription Drugs Executive Director Meghan Scott discusses the negative consequences of rising drug prices. She asserts that pharmacy benefit managers are vital to lowering costs, as they help develop tailored programs for organizations to help achieve savings.
Allowable Cost Reimbursements Under Federal Healthcare Programs Need Transparency
National Community Pharmacists Association CEO Douglas Hoey explains that independent community pharmacists can work with providers and patients to offer cheaper generic options for medication. Hoey believes pharmacy benefit managers have the power to set rates for consumers, and federal legislation should bring greater price transparency.
Redesigning Health Care
Redesigning New Jersey’s Medicaid Program: Philanthropy Steps Up
Nicholson Foundation COO Joan Randell and Senior Healthcare Program Officer Rachel Cahill outline their plan to modernize Medicaid in New Jersey. The report consists of more than 20 recommendations and brings together government officials, advocacy groups, health plans and hospital leaders.
With AHCA Defeat, Some Democrats See Chance to Push For Universal Coverage
The Washington Post
Political correspondent David Weigel shares that some Democrats are using the collapse of the Republican health care bill to push for a single-payer system. Several lawmakers are seeking expanded coverage as the next step in reforming the health care system.