Health-Care Policy One Year into Trump

Bloomberg BNA Health Law Reporter

Bob Atlas, a Strategic Advisor and President of EBG Advisors, Inc., in the firm’s Washington, DC, office, authored an article in the Bloomberg BNA Health Law Reporter, titled “Health-Care Policy One Year into Trump.”

Following is an excerpt (see below to download the full version in PDF format):

As 2018 begins and the United States approaches one full year with Donald Trump as president and the 115th Congress controlled by Republicans, it is perhaps time to take stock of the shifts that have occurred in health-care policy.

Our nation has witnessed an energetic effort by the White House and Congress to put their stamp on health care, highlighted by the attempt—so far, unsuccessful—to repeal and replace the Affordable Care Act (ACA). However, legislative measures, such as repeal of the ACA's individual mandate to purchase health insurance in a GOP tax overhaul that also imposed significant changes for tax-exempt health-care providers, could have a substantial impact on the industry. In addition, actions taken by the executive branch—from presidential executive orders to agency rule-making—have generated uncertainty and some fear in the health-care industry and among the large segments of the population whose health-care coverage and access are affected.

It would seem that the deepest concerns are held by safety net and rural health-care providers, those most dependent on public coverage and financing programs. These providers see threats in efforts to curtail Medicaid eligibility and reductions in Disproportionate Share Hospital and 340B funding streams, plus President Trump's cessation of cost-sharing reduction payments for low-income individuals buying health plans on the exchanges.

By the same token, some providers may feel a modicum of relief from the administration's moves to ease regulatory burdens on clinicians. Before his abrupt resignation, Health and Human Services (HHS) Secretary Tom Price made clear his desire to unburden physicians and other practitioners of demands imposed by both the ACA—such as mandatory bundled payment programs—and by Medicare's Quality Payment Program, a creature not of the ACA but of the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

Even with Price gone, the administration, acting through Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, has signaled intent to back away from some provider regulation and from promotion of certain value-based payment (VBP) initiatives that require providers to assume some risk for costs of care incurred by a population. Though some split in this policy is evident: while Medicare providers may see less emphasis on VBP, CMS continues to press for more use of VBP in Medicaid.

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