Out at HHS:
Tom Price resigned as secretary in September.
In at HHS?
Alex Azar is the new nominee to run the department.
Will see major changes:
The CMS Innovation Center
The Affordable Care Act is still the law of the land.
A key question:
How much support will CMS show for value-based payment models going forward?
The passage of the Affordable Care Act (ACA) was momentous for the healthcare industry, so it follows that repeal of that act would also have sent major shockwaves through every sector. While the Republican Party had been promising to do so for several years, it wasn't until the results of the 2016 presidential election were known that it became a distinct possibility.
The road to repeal, however, was littered with obstacles, and for the moment, the effort is stalled. But healthcare professionals have been on the edges of their seats this year as Congress debated repeal and replace legislation from the overhaul outlined in the Better Care and Reconciliation Act to the less impactful “skinny repeal” bill.
It seemed that every few days this summer featured an announcement about an agreement, a new bill draft, a vote planned, a vote pulled or a statement that perhaps Congress should move on to other matters.
The moment of highest drama came in late July, when Sen. John McCain (R-Ariz.) returned to his maverick roots and flashed a thumbs down that doomed the skinny repeal bill. That vote is arguably the closest Republicans came to repeal this year. Throughout the summer, agreement within the party was never settled enough to get a bill passed, but it hardly rules out another run at repeal in the coming years of President Donald Trump's administration.
President Donald Trump begins his termRead More
The House of Representatives passes the ACA repeal bill called the American Health Care ActRead More
The Better Care and Reconciliation Act to repeal the ACA is declared deadRead More
Senate vote on 'skinny repeal' bill failsRead More
The CMS proposes canceling, rolling back bundled payment programsRead More
Another ACA repeal bill, called Graham-Cassidy, is shelvedRead More
HHS Secretary Tom Price resignsRead More
Trump issues executive order loosening benefit requirements and then ends cost-sharing reduction payments to insurersRead More
Uncertainty in 2017
The White House transition brought with it numerous other changes, and more could still come. The Trump administration has made deregulation a priority, which has repercussions for the 21st Century Cures Act and other areas. And while full repeal of the ACA has not been successful, HHS has chipped away at the law with a variety of funding cuts and regulation changes. The decision to end cost-sharing reduction payments to insurers could have a substantial destabilizing effect on the individual market, which could also see lower enrollment because of dramatically scaled back promotion efforts.
In August, the CMS proposed eliminating some bundled payment programs and rolling back others. A number of providers, patient groups and health systems have disapproved of the change, as bundled models have shown some promising results. Others agree with HHS and say mandatory participation in those models hamstrings providers. Executives who have seen success with bundling, though, say making them mandatory is essential.
Another question mark is the future of the CMS innovation center. This September, the CMS issued a request for information that said the agency is “setting a new direction” for the Center for Medicare and Medicaid Innovation (CMMI). CMMI’s projects have garnered mixed reactions from providers, but the center is seen as a catalyst in the movement toward paying for value. Staff from the CMS under President Barack Obama said they saw CMMI as a way to prod the commercial sector to experiment more with value-based models.
One of the more unexpected moments of uncertainty came in late September, when HHS Secretary Tom Price resigned amid reports he and his staff traveled on private jets to various official events. Politico broke the story, and reported the final tally for Price’s travels was more than $1 million.
Last month, Trump announced former pharma exec Alex Azar as nominee to replace Price. Azar has spoken out in favor of ACA repeal, but isn't on the record for many other issues. Premier CEO Susan DeVore did say Azar was supportive in an earlier stint at HHS as the company developed early value-based payment models. His effect on the department could be stabilizing (assuming Congress approves the nomination), but that remains to be seen.