On Monday, March 13, Healthcare Informatics Editor-in-Chief Mark Hagland interviewed two healthcare industry observers regarding current developments in federal healthcare policy. Hagland interviewed Jeremy Miller and Miranda Franco just hours before the news broke of the “scoring” of the American Health Care Act (AHCA), the healthcare legislation introduced by Republican leaders of the House of Representatives on March 6, to replace elements of the health insurance provisions of the Affordable Care Act (ACA), passed by Congress and signed into law in March2010 by President Barack Obama. The Congressional Budget Office (CBO) announced late Monday afternoon that, while it anticipated that the AHCA could reduce the federal budget deficit by $337 billion over 10 years, it would also lead to the loss of health insurance coverage of 24 million Americans over that same period of time.
Miller is managing partner in the Miller Health Law Group, a Los Angeles law firm with eight attorneys, all of whom specialize in healthcare law. Franco is senior public affairs advisor at Holland & Knight, a Washington, D.C.-based law firm heavily involved in advocacy issues in healthcare and other areas. Franco does advocacy work on behalf of the Cooperative of American Physicians, Inc. (CAP), a California-based provider of medical professional liability protection and other services, while Miller is involved with CAP in an educational role.
In separate interviews, Miller and Franco answered questions from Hagland around a number of federal healthcare policy topics—the current activity in the U.S. Congress around the American Health Care Act (ACHA), the Republicans’ plan to replace some of the health insurance aspects of the Affordable Care Act (ACA); potential modifications to regulations under MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), including to the MIPS (Merit-based Incentive Payment Program); and potential federal healthcare policy changes coming out of the Department of Health and Human Services, under the new Secretary of Health and Human Services, Tom Price, a former Republican congressman from Georgia.
Why did the AHCA focus solely on health insurance? “It’s largely political,” Miller says. “This is what the Republican Party and President Trump campaigned on, and also what’s been in the public eye. And the content involved in [internal health system reform], around bundled payments and readmissions work, was pretty much under the radar” for federal legislators. Still, he says, numerous federal healthcare policy changes could take place within the administrative sphere, under Tom Price, the new Secretary of Health and Human Services (HHS), and a former Republican congressman from Georgia. “The fact is, a lot can go on below that radar, at the sub-regulatory level, partly based on the fact that Dr. Price is the new HHS Secretary.”
Going back to potential eventual federal legislative action, Miller says that “If any significant repeal-and-replace legislation is passed, that could affect the Center for Medicare and Medicaid Innovation [CMMI] and other things” related to internal health system reform. “Dr. Price has indicated that he’s not a big fan of mandatory bundled payments; he’s indicated hostility towards Medicare audits of doctors. So there’s a great deal that can take place independent of the ACA legislation.”
Can healthcare IT leaders begin to plan more safely around the retention of the internal health system reform provisions of the ACA, now that the Republican ACA-repeal legislation has been introduced, and it focuses solely on the health insurance aspects of the law? “Yes,” says Franco, but with a few qualifications around budgeting. “This [bill] is pretty much the first step in three steps. The fact that Medicare was untouched was purposeful. This first leg, the AHCA, was intended to pass under budget reconciliation, which means that only provisions that have a tax or revenue component can be included. The purpose under Title I was to address taxes under [the] Ways and Means [Committee], and Medicaid, under [the] Energy and Commerce [Committee]. The Republicans had said that Medicaid was fiscally unstable and had to be addressed. So it’s no surprise that they would address Medicaid issues first.”