Tuesday, 22 November 2016 00:47

Trump Effect on VBP, Healthcare Industry Anyone’s Guess

Written by Mark Spivey

“We are now all rooting for his success in uniting and leading the country,” President Barack Obama solemnly said of President-Elect Donald Trump during a speech delivered outside the White House the Wednesday after Election Day.

Behind Obama, smiling, Vice President Joe Biden silently made a sign of the cross – and a viral video was born.

Some reactions in the healthcare industry weren’t all that different, as the prospect of a Trump presidency has thrown into uncertainty the future of value-based purchasing, the Patient Protection and Affordable Care Act (PPACA), and a slew of other provisions.

In an article published earlier this month by Healthcare Informatics, Jeffrey Smith, vice president of public policy at the American Medical Informatics Associations (AMIA), described the current position of Trump and fellow Republicans who earned majority leads in both houses of Congress as a “holy crap, we’re in charge now” realization.

“What that will do is force people to move from talking points and get into the details of policy,” Smith said. “They will find that this is an incredibly tightly wound ball of yarn, and we cannot pull on one string and unravel it all.”

Echoing calls congressional Republicans have made for years, Trump repeatedly hammered away at the PPACA on the campaign trail, saying it was his intention to repeal and replace the controversial legislation that was arguably the most high-profile hallmark of the Obama presidency. But his stance appeared to soften somewhat in the days following the election, when he said during a 60 Minutes interview that he planned to keep two of the Act’s most popular provisions: that which bars healthcare insurers from denying coverage due to preexisting conditions, and that which allows parents to keep their own children on their coverage plans until their mid-20s.

Los Angeles Times columnist David Lazarus labeled that stance as indicating Trump is “in favor of dessert, but doesn’t want any Brussels sprouts – yet he also noted that the President-Elect might not have a choice.

“If Trump and his conservative cohorts want to keep this provision of the law, they’ll also have to accept what is arguably the least-popular aspect of Obamacare — the mandate that most people who don’t receive insurance from an employer purchase coverage on a state-run exchange,” Lazarus wrote in a Nov. 14 column. “They can fantasize all they want about separating the two elements. But in the cold, hard light of economic viability, there’s no pulling them apart. They are inextricably linked.”

Healthcare consumers’ reaction to Trump being elected was to spring for PPACA coverage while they still have the chance. Modern Healthcare reported last week that Healthcare.gov was buzzing the day after the election – there were about 100,000 enrollments, marking the largest one-day surge of its kind to date – while the Centers for Medicare & Medicaid Services (CMS) noted that more than 1 million people have selected a plan through the federal marketplace in the first two weeks of open enrollment.

About a fourth of those plan selections were made by new marketplace customers, while the rest were made by shoppers returning to the exchange to renew their health coverage for 2017, the publication reported.

“Consumers are concerned,” Jennifer Sullivan, vice president of programs at Enroll America, a D.C.-based nonprofit group that helps people enroll, was quoted as saying. “They value this coverage, and they want to do everything they can to make sure they are well-positioned to keep it next year.”

Other reports offered up a mixed bag of predictions. Congressional Quarterly reported last week that GOP committee aides say Republicans are mulling several options for repealing and replacing the PPACA “with an eye toward making sure that people don’t lose their insurance coverage.” Politico called congressional Republicans “confident” at the prospects of repealing the Act, rather ominously adding that any replacement legislation could happen “later” while additionally suggesting that Trump could “peel apart other pieces” of it through executive actions.

The Washington Examiner even reported that Republicans were considering “a plan to repeal Obamacare before … Trump takes office,” according to Senate Majority Whip John Cornyn (R-Texas). For the plan to succeed, however, the Examiner noted, Republicans would have to use a budgetary maneuver called reconciliation, which requires only 51 votes instead of 60.

Healthcare Informatics described the political upheaval as requiring that the healthcare IT industry immediately move to consider the short- and long-term implications for polices.

“What are the prospects for healthcare legislation in Congress during the lame-duck session? With a Republican-controlled Congress beginning in 2017, how will the landscape for legislative activity change? What will be President-elect Trump’s healthcare policy priorities and how will that impact health IT initiatives?” the article asked.

The publication quoted a voice of optimism from Tom Leary, vice president of government relations at the Chicago-based Healthcare Information and Management Systems Society (HIMSS).

“I do believe that the House and Senate are still are very much interested in ensuring the U.S. maintains its high level of superiority in biomedical research and the tenets of the Cures Act, whether it’s passed now or a newer version comes up in the new year,” Leary reportedly said. “(It) is really (intended) to keep the U.S. at the forefront of biomedical research, well into the 21st century. That’s bipartisan and bicameral, that’s a national priority.”

Healthcare Informatics also noted that Leslie Kriegstein, vice president of congressional affairs for the College of Healthcare Information Management Executives (CHIME), urged those in the industry to keep in mind that the Health Information Technology for Economic and Clinical Health (HITECH) Act and the PPACA are two different pieces of legislation, which would keep regulations like Meaningful Use separate.

“It would be very hard to just ‘turn it off,’” Kriegstein said. “You also have tens of millions of Americans reliant on healthcare. But for health IT implications, it will cause a distraction.”

Leary even reportedly went so far to say that in spite of the more blustery rhetoric, he does not anticipate any fundamental changes to the idea that value-based purchasing represents the future of healthcare.

“MACRA (the Medicare Access and CHIP Reauthorization Act)was passed on a very strong bipartisan basis to move us towards value-based reimbursement and care delivery, so I fully anticipate that the foundational needs of healthcare with respect to the needs of health IT to be interoperable, so that quality metrics can be reported and patient information on the right patient gets to the right provider at the right time,” Leary said. “Those are still going to be priorities in any changes to overall healthcare policy, so we really have to continue to deliver on making interoperability more and more of a reality.”

Yet Smith expressed serious concerns about the bigger picture as it pertains to federal agencies such as the U.S. Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONC).

“Any time there is a transition, there is a brain drain, which includes thousands of political appointees below the cabinet positions too,” he was quoted as saying in the Healthcare Informatics article. “I just can’t imagine a more stark contrast between most of Obama’s Cabinet and political appointees and what will be Trump’s Cabinet and political appointees. It’s not at all clear to me that the same talented and intelligent people will turn up for the job.”

Smith further noted that a Trump presidency more or less guarantees the exit of current HHS Secretary Sylvia Mathews Burwell, who he labeled “a technocrat who understands the complexities and how difficult change is.”

In summary, only time will tell. After Inauguration Day, a little more than two months from now, the healthcare industry will start learning much more about its future.


About the Author

Mark Spivey is a national correspondent for VBPmonitor.com. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it.

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Last modified on Wednesday, 23 November 2016 17:35