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?
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