The Health Care Blog – Page 340 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Age of Trumpian Uncertainty

Nov 14, 2016• 3

By PAUL KECKLEY

Paul Keckley The new Chief Executive Officer of the United States of America Inc. will take office January 20th and likely make good on his promise to repeal the Patient Protection and Affordable Care Act. It only requires a majority in both houses of Congress to pass and that’s assured based on the election results last week.

Immediately, the focus will shift to its replacement which is certain to be more complicated. Speculation about how his healthcare team will craft its own version of health reform 2.0 is at fever pitch. Questions are swirling about pieces of the law that might be carried over and those that might get the ax….
Will the Trump C suite align its replacement policy with Speaker Ryan’s “Better Way” though the positions of the two seem somewhat at odds, especially around reforms to Medicare including its transition to a premium support plan that encourages seniors to purchase coverage from private insurers with subsidies up to $8000 per senior?
What’s to become of the ACA’s insurance mandates for employers and individuals? Do they go away?
Will excise taxes paid by insurers, medical device manufacturers and increased personal income taxes paid by U.S. federal taxpayers be refunded since they were included in the ACA as a means of funding the trillion-dollar program?
How will President Trump deliver on promises to make healthcare affordable while keeping the ACA’s guaranteed issue restrictions on insurers?
How will Medicaid expansion be a funded in the 31 states that chose to accept the federal deal in the ACA, and what’s it mean for the 19 states that didn’t?
What becomes of alternative payment programs like accountable care organizations, bundled payments, value-based purchasing and others that have consumed a considerable time and attention by provider organizations?
And as the fourth marketplace enrollment period nears ends in January, what’s to become of the tax subsidies for the 12 million expected to enroll?
And beyond the ACA’s repeal, speculation about appointments to the Supreme Court and key healthcare agencies, strategies to allow importation of prescription drugs, how the Justice Department will weigh in on industry consolidation, private inurement and many other issues is running high as the team Trump’s health policy agenda takes shape.

Healthcare’s sky isn’t falling; President-elect Trump’s path forward

Nov 14, 2016• 4

By GARY MENDOZA

Friday, Healthcare IT News reported that most healthcare executives “express a dystopian view of a Trump presidency’s impact on healthcare”.

While significant changes to the ACA and beyond are coming, the sky won’t be falling any time soon.

Political reality, market and fiscal pressures and President-elect Trump’s statements before his election and since make that clear.

Here’s what lies ahead.

What will change. Trump’s election will accelerate the ACA’s demise.

His victory won’t be its cause.

The ACA’s combination of a weak individual mandate, broad mandated benefits and guaranteed issue hard-wired that outcome.

The individual mandate is the ACA’s least popular provision. That’s why the Obama Administration weakened it during implementation. It’s certain to go.

Dear Mr. President-Elect, about that Ryan Plan Thing

Nov 13, 2016• 28

By MARGALIT GUR-ARIE

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The American people, myself proudly included, chose to send you to Washington DC to do their bidding. That’s what happened on November 8^th 2016. Everything you hear now from the elite punditry is aimed at obfuscating this simple truth. Forget about dainty glass ceilings, we the people were able to break through the fortified ramparts erected by entrenched money and power and exercise our right to govern ourselves. I would caution the smug intelligentsia against underestimating the wisdom of the people once again, and I would caution you against forgetting who sent you there and why we did so. We now know we have the power, and what the people giveth, the people can taketh away.

RYANCARE

The ecstatic welcome you received from Paul Ryan and Mitch McConnell the other day looks more like an act of violence than one of true reconciliation. Fair weather friends are usually there because they want something, and in this case they want to highjack the people’s agenda and replace it with their own conservative garbage. Mr. Ryan in particular has been proposing bogus alternatives to Obamacare with alarming regularity. Similar to Obamacare, Mr. Ryan’s health reform plan is based on belief in his own superior intelligence and devoid of any evidence that it can indeed work. Unlike Obamacare, the Ryan plan is also based on the assumption that helping the poor get poorer and the rich get richer is the ultimate role of government.

It Isn’t News That Trump Wants to Keep Pre-Existing Condition Reforms

Nov 13, 2016• 3

By ROBERT LASZEWSKI

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The Wall Street Journal, The Washington Post, CBS News and other news outlets have led with headlines over the weekend touting the big news that Donald Trump is willing to keep parts of the Affordable Care Act––notably the pre-existing condition protections and the ability for children up to the age of 26 to stay on their parents policies.

Except this isn’t news.

In May, Trump’s policy advisor told Healthline that a Trump administration would consider keeping the children to age 26 provision.

And, then there is this February debate exchange between Trump and a CNN moderator:

TRUMP: “I want to keep pre-existing conditions [the Obamacare provision that prohibits insurers from denying coverage]. I think we need it. I think it’s a modern age. And I think we have to have it.”

DANA BASH: “Okay, so let’s talk about pre-existing conditions. What the insurance companies say is that the only way that they can cover people is to have a mandate requiring everybody purchase health insurance. Are they wrong?”

A Vote For Trumpcare

Nov 12, 2016• 59

By NIRAN AL-AGBA, MD

The world is not going to end. We witnessed a revolution earlier this week. The people have spoken and they chose the anti-establishment, street smart, government shrinking candidate who bucks the status quo. We find ourselves in uncharted territory, with an unpredictable President-elect, who has unclear plans for healthcare. Here is what we do know. Mr. Trump is a successful entrepreneur. Forbes describes the entrepreneurship pathway as having no clear story line, but a “sense of chaos, hectic decision making, and moments of great fear and doubt.” Improving our broken healthcare system will involve decision making in the face of great uncertainty. Mr. Trump has a well-developed tolerance for this sort of ambiguity and is likely the right man for the job.

Mr. Trump won over the white working-class individuals in small rural areas. Sluggish economic recovery in these areas played a significant role in his unanticipated victory. It is these disenchanted individuals watching the American Dream slip through their fingers who voted for Mr. Trump. Those same people want the freedom to buy the insurance they need, and not what the bloated government shoves down their throats. 25% of the population lives in rural areas yet only 10% of the physicians practice in there. Physicians are leaving the system in droves, closing their patient panels, and not keeping up with demand, thereby threatening patient access in these isolated locales.

So what does Trump mean for new health tech?

Nov 11, 2016• 23

By MATTHEW HOLT

Matthew-Holt-color I’m a pundit who like everyone else was surprised by Trump’s victory in the (profoundly undemocratic and hopefully-to-be-abolished-soon) electoral college, and everything I say here is prefaced by the fact that there was very little discussion of healthcare specifics by Trump. So there’s no certainty about what will happen–to state the obvious about his administration!

What we do know is that Trump said he’d repeal & replace the ACA and the House has voted to repeal it many times (but the Senate has only once & Obama has always vetoed that repeal). A full and formal repeal requires 60 votes in the Senate which it won’t get with the Democrats holding 48. Note that the Democrats needed 60 votes to to forestall a Republican filibuster in order to pass the ACA in 2010. That 60 vote total is a very rare state of events which existed for only only one year–from Jan 2009 until Scott Brown won Ted Kennedy’s old seat in Jan 2010 and one we likely won’t see again for many years.

But this doesn’t does not mean things will continue as usual for two reasons. Congress can change the budget with the Republican 52 seat Senate majority, and the Administration can change regulations and stop enforcing them. So we have to assume that the new Administration and its allies(?) on the Hill will roll back the expansion of Medicaid which was responsible for most of the reduction in the uninsured (even if it didn’t happen in every state). They’ll also reduce or eliminate the subsidies which enable about 10m people to buy insurance using the exchanges. Both of those were in the repeal bill Obama vetoed, although in the bill the process was delayed for 2 years.

This of course may not happen or may be replaced by something equivalent because many of the people who voted for Trump (the rural, white, lower-income voters) fall into the category of those helped by the law, and in a few of his remarks he’s also said that he’ll be taking care of them. Even this week Senator Wicker (R-Mississippi) said that they weren’t going to take away 20 million people’s insurance. In Kentucky which went from a Democratic to Republican governor 2 years ago, the new administration ended their local exchange (from 2017), but in fact not much consequential happened as people were sent to the Federal exchange. If there are changes to the exchanges and the individual mandate or they’re both abolished, there’ll be lots of commotion but it won’t be completely system changing.

My day job at Health 2.0 involves running a conference and innovation program based on a community of companies using SMAC technologies to change health care services and delivery–either by starting new types of health care services or selling those technologies to the current incumbents. So I’m acutely interested in what happens next, albeit somewhat biased about my preferences!

Overall I think that (unlike many other areas of American life) health care technology won’t be that greatly affected. Continue reading…

Deciding the Future of the Veterans Health Administration

Nov 11, 2016• 4

By JOEL KUPERSMITH, MD

The waitlist scandals of 2014 opened a broad discussion on the future of the Veterans Health Administration (VHA). The immediate Congressional response was an Act that funded the Choice Program whereby VHA enrollees could obtain care in the community under certain circumstances. The same Act also mandated the blue ribbon Commission on Care Report and VA’s Consolidation Plan, both of which had wide-ranging plans to change VHA as have similar documents by veteran service organizations (VSOs).

A central component of these plans and proposals are options for community providers to care for VHA enrollees. Although VA had only 90 days to implement the Choice Program and it has had administrative difficulties, 1 million of the 9 million VHA enrollees have received part of their care in the community via the Choice Program.

Repealing and Replacing the ACA: A Whole New Ball Game. Same Problems Though.

Nov 11, 2016• 6

By STEVEN FINDLAY

I’ll dive right in, with the stipulation that this blog is initial reaction in a very fluid, unprecedented and soon-to-be even-more-intense political environment. Fasten your seat belts!

The ACA. Replace is the critical word in “repeal and replace.” Consensus is already emerging that Trump and the Republicans will indeed repeal the ACA in early 2017, via the reconciliation process Congress used earlier this year. That resulted in the Senate’s first an only full ACA repeal vote. Obama vetoed the bill, of course. But Republicans demonstrated the do-ability of the reconciliation process. Lacking 60 votes in the Senate, they’ll very likely try repeal again that way.Continue reading…

Dancing on the Grave of Obamacare: Questions

Nov 10, 2016• 8

By JOE FLOWER

I hate to interrupt the festivities, but I have a few questions. There are one or two little unknowns here. The answers to these questions are matters of life and death to many in the industry, literal life and death to many thousands of patients, organizational life and death to thousands of companies, hospitals and systems.

Tuesday’s extraordinary events obviously present an enormous challenge for anyone who wants to think about the future of healthcare. The challenge is far more than simply trying to imagine the healthcare industry without Obamacare, or under whatever Trumpcare will turn out to be. A much more powerful effect will be come into play far earlier: the uncertainty over that future will have reshape the industry before we even get to the actual “repeal and replace” part.

An Early Prognosis: What Will Become of Healthcare IT in the Age of Trump?

Nov 9, 2016• 5

By PETER WILEY

In the United States, it’s the Day After. The future of American policy – from immigration to foreign trade to national defense – is full of kinetic uncertainty. One thing is certain: that Donald J. Trump – who has brought something very different from palpable policy proposals to the American electorate – is President Elect of the United States.

There is no shortage of morning-after polemic: some are crying, some are celebrating, and others still are sleeping off the night. Whatever one’s political belief, our industry is perhaps at the center of the new sea of trumpian uncertainty. Indeed, the future of healthcare in the United States, and particularly the role of technology in healthcare, is neither bright nor grim. Unlike last night, it’s too early to call.

What we know about Trump and healthcare is both frustratingly limited but also widely telling. Trump has summarized his post-Obamacare vision as a system that boasts “lots of plans” that will function amorphously across state lines, toppling a partly imagined barrier against competition among plans in different states. We know he views the Affordable Care Act as a “disaster” and, like other drivers of federal spending, sees dealing with corruption, overspending, and “bad deals” at the core of the still-unknown solution to healthcare’s many woes.