In my Nov. 11 column, I talked about the signal-to-noise ratio problem on health care policy, post-election. It was clear at the time that change was in the air. However, it was too early to understand the election’s implications for fundamental change in the nation’s health care system. With a month passed, and two important appointments made, I want to address the issue again.
Throughout the past weeks, President-elect Trump’s nominations for the U.S. Department of Health & Human Services Secretary and the Centers for Medicare & Medicaid Services Administrator have strengthened the signals that the administration is sending. Both nominees have records that may foreshadow the administration’s priorities at the onset and throughout the next four years.
In late November, Trump nominated Congressman Tom Price, Republican from Georgia — a physician and fierce critic of the Affordable Care Act — as HHS Secretary. As a provider, Price has a deep understanding of delivery of care at the front lines. As Chair of the House Budget Committee, he understands the federal bureaucracy — despite a lack of agency experience. His record and rhetoric suggest that he’ll be a central player in the administration’s avowed ACA repeal and replace effort.
Trump’s nominee for CMS Administrator is Seema Verma. She is a health care consultant that has worked to help several states craft Medicaid programs — pre- and post-ACA — around conservative principles. Most recently, she participated in Vice President-elect Mike Pence’s ACA Medicaid expansion reboot in Indiana, Healthy Indiana Plan 2.0, and assisted Kentucky Gov. Matt Blevin’s revisions of the Kynect system.
Verma has worked on Medicare issues in the past. However, the majority of her work in recent years has focused on Medicaid. Since she likely will be one of only a handful of CMS administrators who work in a confirmed rather than acting status, this is a strong signal for change in the Medicaid program.
Although gaining Senate confirmation is more than a formality, Price and Verma are the likely appointees. Moreover, there has been a growing chorus of voices from Congress and the transition team that ACA repeal will be an early, if not first, legislative priority. However, ACA repeal is the easy part. Finding a plan that can replace the law — including the enormously popular insurance reforms — while addressing coverage for the millions of Americans who would lose it under a repeal without a replace, is the real challenge. Of course, there’s the political problem of lost coverage. Perhaps more important still, is the challenge of maintaining the integrity of the health insurance system. The reforms without coverage expansions create imbalance in the risk pool, which could be catastrophic for insurance companies.
Rep. Price has offered numerous health care related bills during his tenure in Congress. Many of his ideas are included in Speaker Paul Ryan’s “Better Way” policy recommendations. As a provider and policymaker, he has voiced his belief that government has too prominent a role in controlling how health care is delivered. In addition, he believes that health care consumers should be empowered to take a more active role in managing their insurance and care.
Verma’s cutting edge Medicaid program design helped shape Pence’s Healthy Indiana Plan that includes a participation fee. She also consulted on the Blevin plan in Kentucky that includes a work requirement and lock out provisions for individuals who fail to pay a small monthly fee for coverage.
Although the Obama Administration generally has been loath to grant waivers that have included work or monetary skin in the game, some believe that the Trump administration may give additional leeway to states for these types of requirements as they shape their Medicaid programs. Although there are a growing chorus of voices warning of the perils of block-granted or per-capita funded Medicaid programs for the states, Verma’s appointment may signal acceptance of fewer federal program requirements for states.
What these appointments certainly signal is Trump’s commitment to taking action on the ACA. Price has been hailed by Pence as the right person to dismantle Obamacare. The choice of Verma, aside from the relationship with Pence and other governors, is a clear signal that conservative innovations in program design will be welcome.
The signals on other aspects of the “replace” portion of the effort remain murky. We know more today about the individuals that will shape the administration’s policies — about their personalities and proclivities. There are still very important questions to be answered.
Is it possible that cuts to payments in Medicare through the ACA will continue without the coverage and associated revenue? Could the federal investments to improve quality and patient safety cease? Will the base number and rate for future federal Medicaid investments include or disregard ACA-related expansions to the detriment of states like Missouri that did not expand? And, will Medicaid financing programs like state provider taxes continue?
The noise will continue, but the signal is getting stronger. These are already shaping our advocacy.
It’s clear that the new administration and Congress intend to review and fundamentally reform the health insurance system, if not the entire health care delivery system, beginning in January. Some of the most critical players in this effort have been nominated.
Hospitals, and every American that is served by a hospital, have a stake in the debate. When the signal strength grows, I’ll share more.
Email me with your thoughts.
In This Issue
Herb B. Kuhn
MHA President and CEO
CMS Innovation Center Announces Two New Beneficiary Engagement Incentive Programs
CMS Releases Final Hospital MOON For Implementation By March 8
New Website Aims To Address Complex Health And Social Needs
New Website Aims To Address Complex Health And Social Needs
Staff Contact: Alison Williams
The Commonwealth Fund, the John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation and the SCAN Foundation have partnered with the Institute for Healthcare Improvement to create a dynamic website addressing the challenges that adults with complex health and social needs face. The website also provides direction on how to meet their needs through a variety of resources that detail care models, policies and more. The collaborative aims to help health care organizations participating in value-based payment models and adopting evidence-based interventions to improve outcomes and lower overall costs of care.
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December 8, 2016
U.S. House Passes Stopgap Spending Bill
Gov. Nixon Withholds And Releases State Funding
Congress Completes Enactment Of 21st Century Cures Legislation
Court Requires HHS To Clear Medicare Claim Appeal Backlog By End Of 2020
MedPAC Recommends Full Marketbasket Update For FY 2018
MLN Connects Provider eNews Available
December 7, 2016
CMS Issues Revision To Appendix W For CAHs
BKD Offers Missouri Medicaid DSH Webinar
Myers And Stauffer LC Announces DSH Audit Survey Training
December 6, 2016
AHA And Federation Of American Hospitals Release Study Of ACA Repeal
OIG Issues Final Rules On Civil Money Penalties And Anti-Kickback Statute
MO HealthNet Extends Deadline For Meaningful Use Attestations
CMS Issues Additional eCQM Reporting Guidance
December 5, 2016
DEA Announces No Grace Period For Renewals
CMS Schedules Webinar For HAC Reduction Program, Hospital VBP Program And HRRP
CMS Releases Supplemental Document To OQR Specifications Manual