Medicare Compliance & Reimbursement

Healthcare orgs say new plan hurts the most vulnerable.

Campaign promises were met on March 6, 2017, as House Republicans unveiled their answer to the Affordable Care Act, commonly referred to as Obamacare. Their take on national healthcare coverage, the American Health Care Act, eliminates insurance requirements, making Medicaid unrecognizable from its current state while keeping the more popular parts of the ACA.

Background: Since its inception in 2010, the ACA has been privy to partisan politics with most liberals championing the plan, which promotes health coverage for all, and most conservatives suggesting it is governmental overreach. Many, including President Trump and most Republican Congressional leaders, promised to overturn the ACA with new legislation.

What’s In: The new plan will still cover individuals with pre-existing conditions. The same goes for coverage up until age 26 under the parents’ insurance. Insurers still can’t set limits on coverage and must still provide “10 essential health benefits, including maternity care and preventive services,” said a New York Times article at www.nytimes.com/interactive/2017/03/06/us/politics/republican-obamacare-replacement.html.

What’s Out: You as an employer are no longer required to offer coverage for employees, and people are no longer required to get insurance if they can afford it. The popular cost-sharing subsidy that helps fill in the gaps with co-pays and deductibles will be phased out by 2020.

Read the full text of the bill here: https://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/documents/AmericanHealthCareAct.pdf.

Note the HHS Dialogue

The HHS releases show strong support for what’s being nicknamed “Trumpcare” by the press, which comes as no surprise as current HHS Secretary Thomas E. Price was a long-time opponent of the ACA during his time as a House legislator.

HHS response: “The American Health Care Act will restore, protect and preserve the doctor-patient relationship — the trusting partnership that is fundamental to quality healthcare,” said Secretary Thomas E. Price, MD in an HHS release. “Our reform effort will ensure patients and physicians are the ones making medical decisions, not Washington, and provide relief to those being harmed by the current healthcare system.”

Price outlined what he considers the positive points of the AHCA and how it will improve and impact the “doctor-patient relationship.” Here’s a quick look at his take on the new coverage initiative:

• Patients will have more control over their healthcare spending habits.
• Patients will be able to choose who their providers will be.
• “AHCA’s Patient and State Stability Fund” will put the onus on the states to drive down costs, protect patients, and implement new innovations.
• “Meaningful access” to procedures will be changed through the new plan.

To read HHS Secretary Price’s release, visit www.hhs.gov/about/news/2017/03/14/american-health-care-act-will-restore-protect-and-preserve-doctor-patient-relationship.html.

Take a Look at the Opposition

Despite the positive HHS output and President Trump’s endorsement, most healthcare organizations find the AHCA to be incomplete and say it downplays recent efforts to put the patient first in medicine.

CBO analysis: A recent report from the Congressional Budget Office (CBO) provided fodder for House Republicans that the AHCA would decrease healthcare spending by $337 billion from 2017 to 2026, mostly through extensive cuts to Medicaid and by getting rid of ACA subsidies. See the CBO report here: https://www.cbo.gov/publication/52486. But the report also highlighted most groups’ biggest objection to the plan — millions of Americans would be left without coverage as early as next year.

AMA rebuttal: As medical groups across the nation weighed in against the new legislation, the American Medical Association (AMA), a supporter of Secretary Price’s nomination, advised the feds to go slowly. The group suggests the swift decisions made with the AHCA are “critically flawed,” and could have far-reaching effects, endangering the health and welfare ofAmericans.

“We have repeatedly heard statements pledging to ‘not pull the rug out from under people,’” said Andrew W. Gurman, MD, president of the AMA in a press release. “The analysis by CBO and other organizations indicates otherwise in stark terms and on multiple levels. As physicians from across the country and on the front lines, we urge the House and Senate to go back to the drawing board to develop alternative policies to provide coverage, choice and affordable healthcare.” Read the AMA’s release at: www.ama-assn.org/patients-doctors-advocacy-groups-express-concerns-about-ahca.

Medicaid: Tax cuts and repeals mandated by the AHCA may impact the long-term solvency of Medicare, the CBO data suggests. But the real loser under the House’s new plan is Medicaid.

“More than 70 million people rely on the Medicaid program for their health care coverage,” said American Academy of Family Physicians Board chair Wanda Filer, MD, MBA, in an open letter to the House Budget Committee chairs. “The AAFP believes that these individuals and families should not face discontinuation of that coverage as a result of any action or inaction on the part of the United States Congress or the Administration.” See the AAFP letter here: www.aafp.org/dam/AAFP/documents/advocacy/campaigns/LT-Budget-AHCA-031317.pdf.

Provider impact: Cutting coverage to millions of these vulnerable beneficiaries suddenly is confusing, she adds, and mentions that the language punishes providers as well, who will be penalized for providing care to patients cut from the program without their knowledge.

Providers of women’s healthcare may be specifically impacted, the AAFP also suggests. “The proposed prohibition of Medicaid payment for some health care professionals and facilities means millions of women would lose access to essential health care,” the AAFP news release said. “Congress would be using the power of federal funding to determine what kinds of care are appropriate for a physician to provide to a patient.”

What’s ahead: Expect more changes to the AHCA as it goes to the House for a vote on March 23. Medicare Compliance and Reimbursement Alert will continue to update readers on the impact the new legislation will have on providers and patients.