By Chris Cheney
With no new healthcare law in place or in sight, President Trump's efforts to recast healthcare reform are in the hands of Tom Price and Seema Verma.
Legislation to repeal, replace, or repair Obamacare has stalled in Congress, but the Trump administration has launched regulatory efforts to transform the federal government's role in the healthcare industry.
Last week, the Department of Health and Human Services published an online summary of the how the Trump administration is crafting its regulatory approach to the Patient Protection and Affordable Care Act until the law can be changed.
"This is the first shot. It may be the only shot, but they are outlining several things that they are going to do with what they consider to be their regulatory power," says Merrill Matthews, PhD, resident scholar at the Irving, TX-based Institute for Policy Innovation.
Providing more flexibility to states in the implementation of reforms and running the Medicaid program are apparently top priorities for Secretary of Health and Human Services Tom Price and Administrator of the Centers for Medicare & Medicaid Services Seema Verma, he says.
"They are going to try to be as flexible as they can possibly be under the law—even to the point where they might get challenged in court."
HHS highlights five regulatory focal points:
- Backing state-driven Medicaid reforms, including increased cost-sharing for patients
- Supporting state innovation such as initiatives designed to strengthen the individual insurance market
- Allowing patients to keep pre-PPACA health plans without facing penalties
- Easing insurer preparation for the HIX market in 2018 such as extending health-plan filing deadlines
- Changing health-plan requirements on the PPACA exchanges to lower premiums such as allowing insurance carriers to offer skimpier coverage and narrower provider networks.
The five points suggest that the Trump administration will have a new regulatory approach to fostering the shift from fee-for-service care models to value-based models, Matthews says.
"One of the things [the Obama administration tried] to do is put in guidelines that you have to comply with to show you are doing better care rather than more care, and you get more money if you are doing what the government says you ought to be doing, and less money if you don't."
"That creates a real problem for the medical system because most doctors feel they are providing very good care—the best care that they can provide—without the government telling them they have to do this as opposed to that," he says.
While the Trump administration and GOP members of Congress are unlikely to abandon value-based care models, Price will likely end mandatory participation in new value-based payment programs, says Michael Adelberg, principal at the Minneapolis-based law firm Faegre Baker Daniels.
"In general, Republicans like value-based models and most are happy to see them move forward; but the Secretary's previous comments suggest he doesn't like when providers are forced into these models," Adelberg says.
'Experimenting in Medicaid'
Until President Trump and the GOP-controlled Congress pass new healthcare legislation, Republican zeal to curb costs in the Medicaid program will be channeled through HHS and CMS.
"They will try to give the states a great deal more flexibility in seeking and receiving waivers to federal rules," says Adelberg, who served in leadership roles at CMS for 15 years, working in the Medicare, Medicaid, and PPACA Marketplace programs. The last title he held at CMS was director of insurance programs/acting director of exchange policy and operations.
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