How Republicans can hobble Obamacare even
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[March 27, 2017]
By Julie Steenhuysen
CHICAGO (Reuters) - Republicans may have
failed to overthrow Obamacare this week, but there are plenty of ways
they can chip away at it.
The Trump administration has already begun using its regulatory
authority to water down less prominent aspects of the 2010 healthcare
Earlier this week, newly confirmed Health and Human Services Secretary
Tom Price stalled the rollout of mandatory Medicare payment reform
programs for heart attack treatment, bypass surgery and joint
replacements finalized by the Obama administration in December.
The delays offer a glimpse at how President Donald Trump can use his
administrative power to undercut aspects of the Affordable Care Act
(ACA), including the insurance exchanges and Medicaid expansion that
Republicans had sought to overturn.
The Republicans' failure to repeal Obamacare, at least for now, means it
remains federal law. Price's power resides in how to interpret that law,
and which programs to emphasize and fund.
Hospitals and physician groups have been counting on support from
Medicare - the federal insurance program for the elderly and disabled -
to continue driving payment reform policies built into Obamacare that
reward doctors and hospitals for providing high quality care at a lower
The Obama Administration had committed to shifting half of all Medicare
payments to these alternative payment models by 2018. Although he has
voiced general support for innovative payment programs, Price has been a
loud critic of mandatory federal programs that dictate how doctors
should deliver healthcare.
Providers such as Dr. Richard Gilfillan, chief executive of Trinity
Healthcare, a $15.9 billion Catholic health system, say they will press
on with these alternative payment plans with or without the government's
blessing. But they have been actively lobbying Trump officials for
support, according to interviews with more than a dozen hospital
executives, physicians and policy experts.
Without the backing of Medicare, the biggest payer in the U.S.
healthcare system which Price now oversees, the nascent payment reform
movement could lose momentum, sidelining a transformation many experts
believe is vital to reining in runaway U.S. healthcare spending.
Price "can't change the legislation, but of course he's supposed to
implement it. He could impact it," said John Rother, chief executive of
the National Coalition on Health Care, a broad alliance of healthcare
stakeholders that has been lobbying the new administration for support
of value-based care.
The move Friday to pull the Republican bill only reinforces the risk to
the existing law, which Trump said on Friday "will soon explode."
"It seems that the Trump Administration now faces a choice whether to
actively undermine the ACA or reshape it administratively," Larry
Levitt, senior vice president at Kaiser Family Foundation, wrote on
"The ACA marketplaces weren't collapsing, but they could be made to
collapse through administrative actions," he added.
NEW PAYMENT PLANS AT RISK
The United States spends $3 trillion a year on healthcare - more by far
than 10 other wealthy countries - yet has the lowest life expectancy and
the highest infant mortality rate, according to a 2013 Commonwealth Fund
report. Link to Graphic: http://tmsnrt.rs/2nkTWoC
Health costs have soared thanks in part to the traditional way doctors
and hospitals get paid, namely by receiving a fee for each service they
provide. So the more advanced imaging tests a doctor orders or pricey
procedures they perform, the more money he or she makes, regardless of
whether the patient's health improves.
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People march in a "Save Obamacare" rally in Los Angeles.
"We have a completely broken economy in healthcare," said Blair Childs,
senior vice president at hospital purchasing group Premier Inc.
"Literally, all of the incentives in fee-for-service are for higher
Alternative payment models are designed to remove incentives that reward
overtreatment of patients. Private insurers are on board, with Aetna
Inc, Anthem Inc, UnitedHealth Group and most Blue Cross insurers
announcing plans to shift half of their reimbursement to alternative
payment models to control costs.
To promote the shift to alternative payments, the ACA created an
incubator program at the Centers for Medicare & Medicaid Services (CMS).
The CMS innovation center is funded by $10 billion over 10 years to test
payment schemes aimed at improving quality and cutting the cost of care.
The Obama administration's decision to make some of these payment
programs mandatory has drawn the ire of Price, a former U.S. senator and
orthopedic surgeon. In response to a mandatory payment program for joint
replacements last September, for example, Price charged that the CMS
innovation center was "experimenting with Americans’ health."
In his January 17 confirmation, Price said he was a "strong supporter of
innovation," but said he believed the CMS innovation center "has gotten
a bit off track."
TRUMP SETS WHEELS IN MOTION ON DAY 1
President Trump has already signed an executive order directing the HHS
to begin unraveling Obamacare. In the early hours of his presidency,
Trump directed government agencies to freeze regulations and take steps
to weaken the healthcare law.
The order directed departments to "waive, defer, grant exemptions from,
or delay the implementation" of provisions that imposed fiscal burdens
on states, companies or individuals. These moves were meant to minimize
the costs and regulatory burdens imposed on states, private entities and
David Cutler, the Harvard health economist who helped the Obama
Administration shape the ACA, said Price could do all sorts of things to
undermine the law.
"If he wants to blow it up, he can," Cutler said in an email. But if
they do, he added, "they alone will own the failure."
(Editing by Edward Tobin)
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