On March 7, U.S. Department of Health and Human Services Secretary Tom Price stood at the podium in the White House press briefing room next to a table with two stacks of paper. The stack on the right was a copy of the Affordable Care Act, clocking in at 974 pages. On the left was the proposed House Republican “repeal-and-replace” legislation, the American Health Care Act, weighing in at a mere 123 pages. (For the CliffsNotes version, you can read the House Energy and Commerce Committee 8-page section-by-section summary of the legislation’s Medicaid and commercial health insurance market reforms, along with the House Ways and Means Committee’s 5-page summary of the tax-related provisions.)
Enacted seven years ago this month, the Affordable Care Act includes ten separate titles (similar to chapters in a book), each addressing a distinct subject matter. Four of the ACA’s titles involve Medicaid and commercial health insurance market reforms. These provisions comprise what is now commonly referred to as “ObamaCare.”
The ACA’s remaining six titles, which total 525 pages, address healthcare payment and delivery system reforms. It is here you will find the legislative mandates for the Medicare value-based purchasing programs (e.g., Hospital Readmission Reduction Program, Medicare Shared Savings Program), as well as funding for the Center for Medicare and Medicaid Innovation (CMMI).
The American Health Care Act deals almost exclusively with ObamaCare. With one exception, the bill does not repeal any provision in the ACA’s six titles addressing payment and delivery system reforms. The exception is Section 4002, which appropriates $2 billion each year to fund prevention and public health initiatives; that funding would end in 2018 under the proposed legislation. Other ACA appropriations, including funding for CMMI, remain untouched.
When “repeal-and-replace” was a campaign slogan, it was an open question whether ACA-driven payment and delivery system reforms would survive under “TrumpCare.” Now, with the release of actual repeal-and-replace legislation (which Secretary Price wants us to call “PatientCare”), it is clear the debate going forward will focus on Medicaid and commercial health insurance market reforms.
Knowing that Medicare value-based payment programs are not currently on the chopping block, and that most commercial payers are committed to similar programs, healthcare providers must look beyond fee-for-service reimbursement. This includes developing core competencies for new payment models by pursuing clinical integration, learning to track and report on quality measures, striving for efficiency, and engaging in performance improvement.