When, after 18 days, the Republican leadership in the U.S. House of Representatives pulled off the floor of the House the American Health Care Act (AHCA), designed to replace portions of the Affordable Health Care Act (ACA), passed by Congress and signed by President Obama in March 2010, the action by House Speaker Paul Ryan (R.-Wis.) on Friday afternoon, March 24, represented the dramatic conclusion to days of Capitol Hill drama.
Speaker Ryan, noting that Republicans lacked the votes to pass his bill out of the House and into the U.S. Senate, on Friday stated that it was clear that the bill lacked the support from within the Republican Party to pass, and thus, that House Republicans were giving up for the time being.
And though the AHCA addressed solely health insurance provisions within the ACA, leaving out any elements related to internal health system reform, nonetheless, its defeat made even clearer that, for the time being, broad healthcare reform legislation would be a non-issue in Congress, as Republicans planned instead to switch to focusing on federal tax reform and infrastructure development issues. By definition, that leaves open certain administrative avenues to create change, particularly under Health and Human Services (HHS) Secretary Tom Price and Administrator of the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, both of whom have been confirmed to their posts in the past couple of weeks.
In the wake of Friday’s developments on Capitol Hill, Healthcare Informatics Editor-in-Chief Mark Hagland spoke with Leslie Krigstein, vice president for congressional affairs at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME). Hagland spoke to the Washington, D.C.-based Krigstein on Monday morning about where federal healthcare policy stands at this moment in its evolution. Below are excerpts from that interview.
Following Friday’s developments in Congress, with the pulling of the AHCA bill from the House of Representatives, what’s your sense of where federal healthcare policy goes from here? Different leaders in the Republican Party said different things; some said very flatly that they would no longer try to repeal the ACA, whereas others implied that they would attempt a repeal-and-replace effort at some point. What are your thoughts?
Depending on who you’re seeing or talking to, yes, there were in fact some shades of gray to the statements that the various party leaders made, that’s correct. My understanding is that they’re going to focus primarily on administrative changes going forward—so whatever is authorized in statute for Secretary Price or Administrator Verma to do, that’s where we’ll see some action. So ACA repeal will definitely take a back seat. Because the next stage of priorities, whether around tax reform or infrastructure, those will be all-hands-on-deck initiatives as well. So we may see user fee agreements reauthorized this year, or CHIP [the federal Children’s Health Insurance Program], because those things have to happen this year.
Tell me more about user fee agreements?
Every five years, the FDA [Food and Drug Administration] along with the pharmaceutical industry, the biological industry, the medical device manufacturers, they basically have to agree on how those products will be approved. This iteration of approvals ends at the end of this fiscal year. That process encompasses drugs, devices, and veterinary drugs as well.
So for now, the major healthcare system reform-related effort is being put away?
Yes. And remember that with the 21st-Century Cures Act [passed by Congress and signed into law by President Barack Obama on Dec. 16, 2016, and focuses on medical research and changing the approval process for new drugs and medical devices but also includes a number of health IT provisions aimed at improving interoperability and electronic health information exchange], there’s still so much in terms of the implementation of those elements, as well as the implementation around MACRA, to do. So the ACA is definitely out of the picture for now, but there’s still a lot of healthcare policy that could be impacted administratively.
What could be on Secretary Price’s and Administrator Verma’s radar that might be within their purview?
They can make changes to the meaningful use program—there have been calls for Stage 3 time changes; and there have also been calls for flexibility under MACRA [the Medicare Access and CHIP Reauthorization Act of 2015]. For example, the Council of Medical Specialty Societies just sent a letter suggesting a hardship category under MACRA. They can change timelines, measures, and reporting periods. And HHS [the Department of Health and Human Services] just launched their new website on regulatory burden reduction. That should be an area to watch. There’s a lot there, and, given the forthcoming announcement of this new position that Dr. Fleming will take on—that might help clarify things. [On March 21, the Department of Health and Human Services announced that it had hired former Louisiana congressman John Fleming, M.D. as a deputy assistant secretary for health technology within HHS, with the hire described as a new-position hire, as Healthcare Informatics reported on that date.]
Just to be clear, Dr. Fleming’s position is not a replacement for the National Coordinator, correct?
Not as far as we know. As far as we know, ONC [the Office of the National Coordinator for Health IT] is intact. And that person would be an advisor to the Secretary. And I haven’t heard much at all in terms of expected responsibilities and roles.
Do you think that Secretary Price and Administrator Verma move quickly in areas within their purview and under their authority?
The IPPS [Inpatient Prospective Payment System] payment rule is already at OMB [the federal Office of Management and Budget, within the administration]. That would be the first opportunity for changes to be made in terms of regulations. But last week, when they pushed back on the bundles [on March 20, CMS officials announced that they were delaying the start and expansion of some of the agency’s bundled payment programs, with the most recently created mandatory bundled payment program, around cardiac care, being delayed from being started, and the orthopedic bundled payment program being paused]—I think they have shown a willingness to act quickly; just the fact that they’re still getting staffed up is why we haven’t seen that much activity; and also the fact that they had all hands on deck for the ACA effort that’s now ended. There was also a hiring freeze that ends on April 3. So yes, I think we’ll see some fairly swift action, and maybe around IPPS and MACRA.
What should healthcare IT leaders be thinking about all of this right now?
It’s hard to know. Our members are feeling some uncertainty about whether changes might come or not around meaningful use and MACRA, given that January 1 has such great implications, with regard to the current rules and regulations. So being cautious to not jump too far in any direction, is a challenge for me, and I would imagine would be a challenge for them. So paying close attention to what’s going on in Washington, will be beneficial, with all the shifts in Congress and in the administration. So they just need to stay the course. And so much is going on that’s not federally mandated—all the private initiatives, for example, will keep our folks grounded. There are just so many questions going forward.