Editor’s note: This is the second post from the Nashville Health Care Council’s 2017 Leadership Health Care Delegation to Washington. The first installment is here and look for more content in the coming days.
Amid snowy conditions in the nation’s capital on Tuesday, Leadership Health Care concluded its annual delegation to Washington, D.C., with informational sessions featuring administration officials and members of the Tennessee delegation to Congress.
U.S. Rep. Jim Cooper (D-Tennessee), a regular presence at the signature Leadership Health Care Event, discussed the Republicans’ American Health Care Act legislation and the Congressional Budget Office’s analysis of the bill, released the day prior, which estimated 24 million Americans will lose their health insurance coverage by 2026 under the plan compared to the projected number of insured Americans under the current Affordable Care Act.
“We’ll actually go back to a worse situation than before Obamacare,” said Cooper. “The good news is the deficit will decrease a little. Great. You’re cutting spending in health care by $1.2 trillion and using that money to fund tax cuts, often for the well-to-do.”
However, Cooper doesn’t think the bill in its current form will become a reality, noting that Senators Susan Collins (R-Maine) and Rand Paul (R-Kentucky) have already come out against the legislation, and there may be others.
“Nothing like this will be able to pass both the House and the Senate,” he said. “This is a hasty, cobbled-together, quick fix — primarily tax cuts for rich people, funded by cuts to your businesses and poor people.”
Later, former U.S. Senate Majority Leader Bill Frist echoed that the bill won’t pass but called it a “starting point to build on.”
Cooper urged business and industry groups to continue speaking out against the bill and saying it’s bad for business and for individuals to keep reaching out to their legislators.
From the other side of the aisle, U.S. Congressman Diane Black (R-Tennessee), a member of the House Ways and Means Committee and chair of the Budget Committee, spoke to delegates. Ways and Means was one of the two committees that reviewed and marked up the AHCA last week. She provided an overview of the process for moving the bill forward through the reconciliation process, a necessary move for Republicans because they lack the 60 votes required to cut off debate and bring the bill to a vote in the Senate.
Black defended the bill as a way to help Americans get the kind of insurance they want — arguing, in particular, that young people were the largest group who paid the penalty for not having insurance under the current law’s individual mandate and that demographic should have an option for more affordable plans designed for the way they use health care.
Asked about the work ahead for convincing the Republican caucus to vote for the bill, given some vocal opposition to date, she said it will be a process.
“Whatever you see today, don’t memorize it. It will change,” she said.
She does not anticipate Republicans getting every caucus member, but that the House will get it “across the line” and into the Senate.
CMS leader talks bundled programs, MACRA reporting burden
Delegates also heard from Patrick Conway, the deputy administrator for innovation and quality and the chief medical officer with the Centers for Medicare and Medicaid Services. Conway provided an overview of the size, scope and duties of the CMS — which accounts for $1 trillion in spending each year and covers approximately 130 million Americans — and a look at the work of the innovation center in developing and testing alternative payment and delivery models.
Conway specifically updated delegates on bundled payments and the Quality Payment Program created under the Medicare Access and CHIP Reauthorization Act. On the former, Conway said there are nearly 1,200 hospitals, physician groups and post-acute facilities voluntarily participating in bundled payments for one or more episodes of care. CMS has approximately $2.5 billion and growing, per quarter, of voluntary two-sided risk payments by providers in every state of the country.
Conway said they’re seeing bundled programs “improve quality and lower cost substantially” and he expects the voluntary programs will be maintained under the new administration, though it’s possible there will be tweaks to some of the mandatory bundle programs to, for example, allow opt-outs.
Together with MACRA — the quality value measurement program for physicians — Conway said the goal of alternative payment programs is to continue providing incentives for improving quality and cost to shift payments to value and outcomes and away from fee-for-service. Given the bipartisan support for MACRA, Conway said it’s unlikely the program will go away under the Trump administration. He and Frist, however, did discuss the likelihood of CMS working with providers in honing in on the quality measures that are most meaningful to reduce providers’ reporting burden.
“Don Berwick, my first boss at CMS, said he thought we had more positive health system transformation in the last three to five years than ever in U.S. history, and I think he was right,” Conway said. “He also said we’ve got a lot more to do.”