Welcome to the brave new world of healthcare policy! During the transition and beyond, athenaInsight will be offering a guide to what's happening in Washington — and how it could affect health IT and healthcare on the ground. Here are seven things to watch this week:
1. 21st Century Cures: the lame duck Congress acts
If you thought the health policy news cycle would be dominated by Trump transition plans and repealing the Affordable Care Act, think again. Not to be outdone, Congress released a major healthcare bill late Friday afternoon. Clocking in at just under 1,000 pages, the 21st Century Cures Act tackles a lot: NIH funding, mental health reform, the opioid crisis, research and development of new drugs and devices, and precision medicine.
For the health IT crowd, the bill includes an entire section on interoperability and the long-awaited provisions to remove all but the highest-risk health IT from the FDA’s jurisdiction. One early provision that had caused some headaches in the health IT crowd has been removed: a whole new EHR rating paradigm that would have sat on top of the existing certification program.
It ain’t over ’till the fat lady sings — or, in this case, Congress votes — but all signs so far point to widespread support in both the House and Senate (despite Massachusetts Senator Elizabeth Warren’s objections).
2. ACA repeal: Where we stand (today)
In a video released last week, President-elect Donald Trump conspicuously did not list ACA repeal in his Day 1 priorities. But House GOP leaders and Vice President-elect Mike Pence were quick to reiterate that dismantling the law remains a top priority.
Meanwhile, the Heritage Foundation seems likely to drive much of Trump transition policy, especially ACA repeal. The conservative think tank has emerged as a leading force in the Trump transition, as many Republicans with ties to the group are named to the transition team. So a new Heritage report outlining plans for ACA repeal is worth reading. The report calls for Congress to initiate repeal immediately, while waiting until 2018 to initiate a replacement plan (they recognize that it's too late to push through a replacement for the 2018 plan year since insurers will be finalizing 2018 offerings by the spring).
The same budget reconciliation process that the House used in testing repeal in 2015 should be used to immediately repeal the major mandates, tax penalties, and other financial provisions, the report argues. And Heritage urges Congress to also repeal rules around plans' age ratings and the essential benefits definition. (You can hear more in Politico podcast with the Heritage Foundation's Ed Haislmeier.)
On the other hand, ongoing litigation challenging Obamacare subsidies presents a possible "nuclear option" for repeal. The House has asked the DC Court of Appeals to pause its lawsuit challenging ACA subsidies. If the court agrees, it would leave the Trump Administration the option to simply stop defending Obamacare, allowing the $5 billion in cost-sharing subsidy payments to health insurers to quietly end. (A lower court had already ruled that the healthcare law didn't properly fund the subsidies.)
This would be the polar opposite of the Heritage Foundation proposal outlined above. It would dismantle the law within a few months, abruptly throwing people off their ACA plans with little notice. Nothing suggests that this is particularly likely, but it's potentially on the table, pending the court's decision.
3. ACA Repeal: Reactions
One state insurance commissioner says that immediate repeal would have disastrous consequences. Iowa Insurance Commissioner Nick Gerhart, a Republican, tells NPR's "All Things Considered" that the Obamacare exchanges need immediate fixes, but that striking down the law overnight would cause "massive disruption" for his state's residents.
Meanwhile, new data shows who would lose coverage if ACA is repealed. An interactive heat map from The Century Foundation takes Department of Health and Human Services data to graph HealthCare.gov enrollment by ZIP code, seeking to illustrate where the ACA's customers can be found.
4. Battle lines struck on Medicare, Medicaid
House and Senate Democrats are weighing in on possible Medicare privatization plans. House Minority Leader Nancy Pelosi told the Washington Post that Democrats must mount a major fight to protect against possible Medicare privatization plans that have previously been touted by Speaker Paul Ryan and Rep. Tom Price, the presumptive nominee for HHS Secretary.
Pelosi noted that Democrats rallied to stop President George W. Bush's Social Security privatization efforts in 2005, which could serve as a roadmap for challenging the same ideas in 2017. And on the other side of the Capitol, Indiana Democrat Sen. Joe Donnelly said that he would fight any efforts to privatize Medicare or turn it into a voucher program.
Providers are also weighing in on proposals to cap federal spending on Medicaid.There are two basic proposals floating around as part of the ACA repeal discussions — one to cap federal funding to Medicaid on a per person basis, and the other to fund Medicaid through block grants to states. Either way, hospitals are warning that this would force them to face deep cuts and leave millions of low-income patients without reliable access to care. Leading the charge is America's Essential Hospitals, a group that represents safety-net hospitals and providers.
5. A new focus on EHRs?
The HHS Office of the Inspector General published its agenda for 2017, and the agency is going to spend a lot of time looking at EHRs and healthcare software. Its plans include: reviewing NIH's data controls to make sure they ensure the privacy of precision medicine volunteers (recall that NIH is seeking a million patients to donate their data for research); reviewing the FDA's plans for addressing cybersecurity flaws in medical devices; reviewing erroneous Meaningful Use payments; audits to make sure MU participants are protecting PHI; and reviewing the extent to which providers participating in ACOs can use EHRs to exchange information for care coordination.
6. Don't open that email!
A phishing email circulated on mock HHS departmental letterhead is prompting recipients to click on a link to a fake HIPAA privacy and security audit program, according to the Office for Civil Rights. The email, which bears the name of OCR Director Jocelyn Samuels, directs those who click on it to a non-governmental website marketing a firm's cybersecurity services.
7. Value-based purchasing: Still coming
CMS just published its list of cost and quality measures under consideration for value-based purchasing programs. The list of nearly 100 metrics for the federal government's use in various health programs — such as MACRA, MIPS, and so on — is being reviewed by the National Quality Forum and is open for public comment until Dec. 2. More details are here.
Stephanie Zaremba is director of government affairs at athenahealth.