As we draw nearer to the time when the Trump administration may unveil its proposals for reforming the Affordable Care Act and the Republicans in Congress may coalesce around a single repeal and replace proposal, two ideas are surfacing that should be addressed and explored—setting a goal of “universal access” rather than “universal coverage” and shifting responsibility for ACA replacement to the states. This post looks at the challenges involved in operationalizing these concepts.
As the Trump administration officially begins later this week, a new HealthLeaders Media survey shows that healthcare industry leaders support changes to the existing law rather than replacing it. Two-thirds of respondents (66%) say the best option for the healthcare industry regarding the Patient Protection and Affordable Care Act is to make some changes but otherwise retain it.
At the opposite ends of the spectrum, 27% favor full repeal and replacement, while only 7% of respondents say keep it as it is, indicating the extent of dissatisfaction with the PPACA.
Interestingly, a greater share of health systems (78%) than hospitals (66%) and physician organizations (65%) favor making some changes to the PPACA.
On the other hand, a greater share of hospitals (28%) and physician organizations (27%) than health systems (17%) prefer full repeal and replacement. This is perhaps an indication that health systems are less able than other providers to accept full repeal and replacement because of their greater complexity as organizations.
Among the 66% of respondents who say that the best option for the PPACA is to make some changes, the top three changes they advocate are adding a public health insurance option (61%), eliminating the excise tax on high-cost employer health benefit plans (‘Cadillac tax’) (50%), and eliminating the individual mandate and noncompliance penalty (37%).
The two changes receiving the fewest responses are eliminating Medicaid expansion (10%) and abandoning the focus on value-based care and reimbursement (16%).
As the professional association for health foundations and corporate-giving programs, Grantmakers In Health (GIH) connects the hundreds of health funders who are spread across the American landscape, keeping them up-to-date on rapidly changing developments and providing opportunities for them to share what they’re learning and doing in their respective communities.
Times like now—when dramatic changes to the health care landscape are anticipated—accentuate the importance of this role. In 2017 it will be especially important that we help funders understand, and respond to, significant expected changes in public policies and programs that affect the communities they serve.
We will not simply be in crisis mode, however. Our concern for both informing and shaping the bigger picture of philanthropy’s health and health care priorities is ongoing.
As the year begins, the future of the Affordable Care Act (ACA) is naturally a high priority for us. Health funders are rightly anxious to understand the changes that are likely with a new Congress and presidential administration. Many grantmakers have invested for years at a national or state level to support the implementation of the ACA. They are keenly aware that rolling back the law will have consequences not only for people’s access to health care services, but also, more broadly, for jobs and state economies.
In an immediate response to these concerns, GIH has organized a series of webinars for its membership that offers the perspectives of a range of policy experts. Immediately post-election, these topics included strategies for adapting health reform–related grant making, the future of Medicaid, and the election’s implications for the State Children’s Health Insurance Program (CHIP) and other children’s coverage. Upcoming webinars will include bipartisan views of the new Trump administration’s health priorities and plans, the implications of a possible repeal of the ACA without implementing an immediate “replace” strategy, and the 2016 election’s possible effects on the health of immigrant communities.
Other ACA-related programming will include activities taking place at our annual conference in June, as well as meetings, calls with funders, and publications, including in-depth interviews about foundation strategies. Because changes to the ACA, Medicaid, and other programs will heighten the importance of state-level actions, our 2017 programming will pay special attention to elevating what funders are doing in states and sharing this information nationally.
In addition to this focus on policy changes that will affect access and coverage, we also want to identify health investment areas in which the new administration seems to be interested. We anticipate that addiction, delivery system reform, veterans’ health, and rural health will be on that list.
Anyone who followed the recent election cycle knows that President-elect Donald Trump made “repeal and replace” a cornerstone of his campaign — referring, of course, to the Affordable Care Act (ACA). He, like Mitt Romney and John McCain did in their respective bids for the presidency, has proposed permitting insurers to sell insurance plans across state lines as a possible alternative to the ACA, or at least as a component of a potential alternative.
In this post, we’ll take a look at the possible advantages of allowing interstate insurance sales, as well as the reasons opponents say such a policy simply won’t work. First, though, let’s take a closer look at the current situation.
A provision in section 1333 of the Affordable Care Act allows states to establish what are called “health care choice compacts,” which permit insurers to sell policies to individuals and small businesses in any state that participates in the compact — provided they abide by specific rules. And several states have explored the possibility. In fact, a few have even enacted statutes pertaining to interstate compacts.
But as of yet, nothing has materialized. Several explanations point to why:
Whatever the reason or combination of reasons may be, the upshot is that interstate insurance sales are already legal under certain conditions.
It’s also important to note that most large companies are self-insured, which means they are not affected by state regulations and this whole discussion of selling insurance across state lines doesn’t apply to them.
2017 will be a transition year shaped by changes proposed by President-elect Donald Trump and a Republican Congress. Chief healthcare concerns include legislative proposals to “repeal and replace” the Affordable Care Act (ACA), along with the continued movement to implement alternative payment models (APMs) as called for in the Medicare Access and CHIP Reauthorization Act (MACRA). We will address the potential changes ahead when it comes to shifting health benefits, provider supply, new care models, transparency, and the continued growth of consumerism. 2017 will be a dynamic year as we pivot and move in a new political direction.
http://www.latimes.com/politics/la-na-obamacare-repeal-costs-20170117-story.html
Repealing Obamacare without a replacement would result in higher costs for consumers and fewer people with insurance coverage, according to a report Tuesday from the nonpartisan Congressional Budget Office.
In the first year, insurance premiums would jump by 20% to 25% for individual policies purchased directly or through the Obamacare marketplace, according to the report. The number of people who are uninsured would increase by 18 million.
Americans may be beginning to worry about such costs. For the first time, more Americans view the Affordable Care Act as a “good idea,” rather than a bad one, according to a new Wall Street Journal/NBC News poll also released Tuesday.
The future of healthcare policy is a bit murky these days. President-elect Donald Trump has pledged to repeal the Affordable Care Act, and the Republican-run U.S. Congress is already fast at work to make that happen.
What’s not known, however, is what will change for the thousands of U.S. healthcare businesses that have not only adapted to the ACA but also made millions in investments in areas such as electronic health records, value-based reimbursement and reporting to align with the policies of the outgoing administration.
Healthcare Finance spoke with several executives at healthcare businesses to get their perspectives on not only the changes they expect but also their thoughts on what the healthcare sector actually needs to do to provide the best care while still safeguarding the health of its business model.
According to Vice-President-elect Pence, “We’re working now on a series of executive orders that will enable that orderly transition to take place even as Congress appropriately debates alternatives to and replacements for ObamaCare.”
This talk about using executive orders to assure an “orderly transition” is a bit confusing. An E.O. has legal force “only if the presidential action is based on power vested in the President by the U.S. Constitution or delegated to the President by Congress.” Authority to implement the ACA, however, is vested in the Secretaries of HHS, Treasury, and Labor—not the President. In the context of the ACA, an executive order won’t be anything more than a document containing a president’s instructions to his subordinates.
That’s why, as Tim Jost details here, President Trump can’t use E.O.s to change the rules that have been adopted to implement the ACA. To do that, agency officials would have to undergo cumbersome rulemaking processes. Guidance documents are easier to withdraw and amend, but an E.O. probably can’t do the job (although strong proponents of the unilateral executive might argue otherwise). Instead, the E.O. would instruct Secretary Price or Secretary Mnuchin to withdraw or amend the guidance that their predecessors adopted.
HENRY KOTULA 