Making sense of the political conflict surrounding healthcare
Friday, February 24, 2017
There are significant risks to crafting new legislation without bipartisan support.
Former President Barack Obama's signature healthcare legislation — the Affordable Care Act (ACA) — did not have bipartisan support, but it was passed when Democrats controlled the federal government. Now that power has swung to the Republican Party, we expect changes to, if not an outright repeal of, this legislation.
It will take some time to go through the process of actually changing the complex set of regulations — at least a year or two while new legislation is written, goes out for public comment and completes the legislative process. In the meantime, healthcare administrators and clinicians are trying to anticipate the changes that will be implemented and where they will find the resources to cover the cost of reworking processes and systems for compliance.
President Donald Trump and his administration have given some early signs of what we can expect. Three recent executive orders and a Health and Human Services proposed rule highlight the potential reinterpretation or clarification of existing law and policy.
Executive departments and agencies with responsibilities under the ACA are permitted to waive, defer, grant exemptions from or delay the implementation of requirements that impose a fiscal burden on any state. They can do the same to any cost, fee, tax, penalty or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchaser of health insurance or makers of medical devices, products or medication.
This could include:
- Revising the hardship exemption criteria to reduce the number of individuals who are penalized for not having insurance
- Reducing enforcement of some rules, seen as wasting resources and/or being counterproductive, such as the hospital readmission penalty "for any reason"
- Increasing flexibility for states, such as allowing them to require participants in Medicaid expansion programs to work or offering insurance options that cross state lines
This executive order is an attempt to manage the cost to public and private sources for complying with imposed federal regulations. For every new regulation, departments and agencies will be expected to remove two others and offset any new costs.
This could include:
- Healthcare being the most overly regulated industry may begin to finally see some relief from costly, outdated and ineffective burdens in a wide variety of areas
- Innovators may realize increased opportunities as a result of lower barriers to entry for new medications, medical devices, etc.
This executive order will primarily affect the academic medicine, biomedical research and biotechnology fields, who draw upon health professionals from the seven referenced countries. This could include individuals being delayed in starting work or entering residency/fellowship programs and organizations needing to adjust their recruitment and processing timelines.
This proposed rule is designed to put downward pressure on premiums, minimize abuses and encourage year-round enrollment. It includes changes to help stabilize the individual and small group markets by providing more flexibility to states and insurers and giving patients access to more coverage options — while future reforms are debated. Comments on this proposed rule can be made through March 7.
This rule aims to:
- Require those who enroll during special enrollment periods to provide proof of qualifying life changes, such as job loss, divorce and new dependents prior to coverage; as is common practice in the employer health insurance market
- Allow insurers to stop coverage for individuals who are more than 30 days late on payment of premiums and to collect premiums for prior unpaid coverage before re-enrollment
- Adjust the range that determines level of coverage to provide flexibility to insurers, so patients have more coverage options
- Reaffirm the traditional role of states by deferring to their assessments of network adequacy and determination that residents have access to high-quality care networks
- Provide insurers with additional time to implement proposed changes that are finalized prior to the 2018 coverage year by adjusting the Qualified Health Plan Certification Calendar
- Shorten the enrollment period to Nov. 1 to Dec. 15, 2017 to align the Marketplaces with the Employment Sponsor Insurance Market and Medicare to contribute to lower premiums
Healthcare professionals know more changes are coming to healthcare, but they hope the new administration recognizes all of the costs of continually reinvesting in compliance. They are also hoping for smooth transition, and perhaps, even for bipartisan support for new healthcare legislation that will lead the industry into the future.
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