Navigating the Politics of the Healthcare Landscape

This fall's ACO & Emerging Healthcare Delivery Coalition^® included a session on understanding the current political atmosphere and payment reform.

With the repeal & replace of the Affordable Care Act (ACA) constantly in the spotlight and several health programs expiring, Clay Alspach, JD, principal of Leavitt Partners, discussed navigating the current political and payment reform landscape, making sense of the uncertainty, and preparing for the unexpected.

“The rule of the past 12 months has been to prepare and expect the unexpected,” said Alspach.

The coming year will be a critical one, focusing on the repeal and replace and other issues of the ACA, drug pricing, opioids, and tax reform.

First, Alspach spoke about the current status of the ACA. Repeal and replace for the ACA has been a dominant issue for the past year. Alspach highlighted 3 phases of repeal and replace in 2017. The first, being repleaing through budget reconciliation, was the foundational piece that was supposed to come from Congress but is no longer coming. Phase 2 is the executive and regulatory phase, and phase 3 is the new legislation phase.

The most recent piece of legislation in regard to repeal-and-replace is the Alexander-Murray bipartisan bill, which is estimated to reduce the deficit by $3.8 billion and will cause no net loss of coverage. However, in order for the bill to move forward, it needs President Donald Trump’s approval, according to Alspach. Right now, it does not.

There are several expiring health programs, including the Children’s Health Insurance Program (CHIP) extension, Medicare extenders, and other health extenders. While it is likely these programs will move forward, there is a looming question of how they will be funded.

CHIP is a program that provides insurance to a number of children and their families across the country. It’s a bipartisan program, and both sides want it to continue, but it is currently expired and not being funded right now. However, Congress has agreed to extend CHIP for 5 years, which will cost $8 billion.

Also at risk is funding for provisions Congress has enacted throughout the years, such as the Work Geographic Practice Cost Index floor, thearpy cap exceptions process, ambulance add-ons, and the Medicad home health rural add-on.

"Medicare extenders are extenders that used to ride along with the sustainable growth rate (SGR), and they are still around as much as the SGR is no longer," said Alspach.

Just last week Democrats and Republicans came together and agreed extending the funding, but, like the money to fund CHIP, there is uncertainty on how the $6 billion or $7 billion for the extenders will be funded.

Other health extenders are other important pieces that are providing some of the political and policy deadlines. For example, Community Health Centers, which provides help for low-income families across the country, is currently expired and needs to be extended. This is likely to be extended for a couple of years, costing around $7 billion.

"The cost of this is going to be worth $20 billion," said Alspach. "What's holding it up right now is how to pay for it. I think everybody would agree this needs to get done."

However, there are differing opinions on how the funds should be allocated.

In regard to drug pricing, the administration has moved forward on generics and putting forward different ways to push forward generics, additional guidance on biosimilars, and education for physicians. One area that is still uncertain is the importation of drugs.