Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

How to Fix Obama’s Affordable Care Act Without a Repeal

While the future for the Affordable Care Act is not clear, healthcare reforms including MACRA and value-based care has bipartisan support.

Now that a new President and a Republican-controlled Congress has been elected, what does the future for healthcare reform and the Affordable Care Act (ACA) look like? What will happen to the Affordable Care Act cannot be answered simply since the Republican Party has not put forth a detailed and flushed-out replacement plan. Speaker of the House Paul Ryan released A Better Way replacement plan in June 2016, but the ideas lacked any clear financial implications or solid steps for keeping health coverage for millions of Americans currently insured under the ACA.

Affordable Care Act

While there may not be a clear pathway to understanding what will actually happen to the Affordable Care Act, The Washington Post outlined steps that Republicans and Democrats in Congress can take to fix the many issues of the Affordable Care Act and potentially reduce the high costs of health insurance premiums.

Part of Donald Trump’s plan is to keep pre-existing conditions covered by health insurance companies and ensure young adults under 26 years of age can remain on their parents’ health plans. However, in order to keep these provisions, other major parts of the Affordable Care Act cannot be repealed such as the individual mandate, which keeps insurance rates more stable and enables patients with pre-existing conditions to have affordable coverage.

One method for reducing the rising rates of premiums on the exchanges could be to increase the threshold of premium costs between young and old. If younger adults face lower premiums, they will be more likely to enter the market and offset the costs of caring for the sick and elderly that payers have been managing through the exchanges over the last several years.

Another policy being picked up by Republican Senators Richard Burr (N.C.) and Orin G. Hatch (Utah) along with Representative Fred Upton (Mich.) is that of changing the tax-free positions for employer-sponsored health insurance. By taxing employer-sponsored coverage, around $260 billion could be picked up to ensure that tax credits could be used for those buying health plans on the exchanges. Other taxes and regulations stemming from the Affordable Care Act could be eliminated, according to The Washington Post.

However, there may be opposition from business and labor advocacy groups. The proposals from Burr and Hatch call for the tax credits to be based on age and income and provide a system in which individuals could buy “catastrophic” insurance to cover unforeseen medical needs.

Also, stronger enrollment periods and continuous coverage mandates are advised, said Joel Ario, Managing Director at Manatt Health, in a prior interview.

“It could be better if there was broader enrollment and that is primarily what insurers want to see,” Ario said. “The second challenge is to make sure that as many people as possible are continuously enrolled in the program, so that payers do not have people coming in and out of the program. These are shared goals between insurers and the Obama administration.”

“One obvious solution is something that CMS has attempted to do within the context of the existing legislation: really tighten up those special enrollment periods so that payers aren’t getting a very negative risk pool,” Ario explained.

What happens to the future of the Affordable Care Act remains to be seen, but certain bipartisan healthcare reforms are here to stay. For example, the push toward value-based care reimbursement, MACRA regulations, the support behind accountable care organizations, and adoption of alternative payment models will likely remain key components of healthcare reform for years to come.

Premier’s Senior Vice President of Public Affairs Blair Childs released a statement in which a call for fewer regulations and incentivizing greater competition among healthcare providers was established.

“The Premier healthcare alliance looks forward to working with President Trump and the Republican Congress to achieve a consumer and healthcare provider led transformation of our healthcare system. We believe that building on reforms, such as MACRA, to advance alternative payment models will achieve measurably higher quality and more cost effective healthcare for Americans. We are proud that members of the Premier alliance have led the way in this transformation, and we intend to continue that leadership by working with them to make strategic decisions for success, including through our MACRA Roadmap,” Childs said publicly.

For issues like value-based care reimbursement and MACRA legislation, bipartisan support will keep these reforms within the payer industry well into the future.

“There is a great deal to be done to transform healthcare. At the top of the list is achieving interoperability of health IT systems, specifically EHRs, which we encourage Congress to address in the upcoming lame duck session. We also believe more needs to be done to incent providers to move to alternative payment models, such as accountable care organizations. This can be accomplished by eliminating cumbersome and antiquated regulations, reducing the level of risk required in establishing these models, and ensuring competition by creating a level playing field for all healthcare providers seeking to enter these models,” Childs concluded.

 

Dig Deeper:

How the Affordable Care Act Changed the Face of Health Insurance

The Progress and Challenges of the Affordable Care Act

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