The Trump administration formally declared its opposition to the entire ACA on Wednesday, arguing in a federal appeals court filing that the signature Obama-era legislation was unconstitutional and should be struck down. The filing was made in a case challenging the law brought by Ken Paxton, the attorney general of Texas, and 17 other Republican-led states. In December, a federal judge from the Northern District of Texas, Reed O’Connor, ruled that the law was unconstitutional.
The Trump administration is making it a top priority to protect doctors, hospitals or other medical providers who object on a moral or religious basis to providing services like abortion, sterilization or assisted suicide. In a 440-page rule issued Thursday, the HHS Office of Civil Rights said it will use a broader array of tools to enforce more than two dozen “conscience protection” laws, some that have been on the books since the 1970s.
Federal health officials on Monday unveiled a new primary care experiment that seeks to pay doctors for providing stepped-up services that keep patients healthy and out of the hospital, an effort they say will transform basic medical services for tens of millions of American patients. The initiative, called CMS Primary Cares, includes five new payment options for small and large providers, allowing them to take varying levels of financial responsibility for improving care and lowering costs. It broadly seeks to change how primary care is delivered in the U.S. by rewarding doctors for improving management of patients with chronic illnesses such as diabetes and high blood pressure and averting expensive trips to the hospital.
The CMS is inviting state Medicaid agencies to pursue new ways of integrating care for patients eligible for both Medicare and Medicaid—a population that has complex health needs and accounts for a big portion of spending in both public health programs. In a letter to state Medicaid directors, CMS Administrator Seema Verma described three new ways states can test approaches to integrating care for dual-eligible patients with the goal of improving the quality of their care and reducing costs for federal and state governments. “Less than 10% of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems,” Verma said. “This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all.”
Reports suggest President Trump is planning to release a health care reform plan soon. That’s good news. Republicans may have failed to pass reforms in 2017, but health care nonetheless remains a major concern for Americans. Since the failed reform effort in 2017, conservative health policy experts spent a lot of time working with colleagues across the country to develop a consensus proposal that could succeed where the previous effort fell short. It’s required some hard thinking about the lessons of previous efforts, as well as the failures of implementing Obamacare. This piece highlights seven lessons that will serve policymakers well in crafting the new plan.
It wasn’t so long ago that Bernie Sanders (I-VT) comfortably occupied the left flank of health care policy. His Medicare For All bill was sufficiently costly, coercive and utopian to set him apart from the pack.
Times have changed. When it comes to drug pricing, Bernie faces unexpected intruders on his left: Republicans.
In recent months, Bernie has yielded socialist turf to two Republicans of impeccable capitalist pedigree. First, it was President Trump, who last fall announced a plan to incorporate drug prices set by foreign governments into Medicare. Then Sen. Rick Scott (R-FL) last week introduced a bill pegging U.S. retail prices for prescription drugs to those set by five foreign governments.
We don’t know what will emerge as President Trump’s plan to replace Obamacare, which he has promised to unveil immediately after the 2020 elections. But he has recently endorsed several proposals, and they could provide clues. A group of conservative health policy experts has developed a health care proposal that would hand states blocks of money and a few rules, and encourage them to develop their own health care systems. The plan would require that government-subsidized systems offer every American a choice of a private health plan, a requirement that would probably foreclose a liberal state from enacting a single-payer program and that might require restructuring of some state-run Medicaid programs.
Acting White House chief of staff Mick Mulvaney said Sunday that the White House plans to release an Obamacare replacement plan before the 2020 election, after hosting top administration officials at Camp David over the weekend for a meeting on health care. “I do think you’ll see a plan here fairly shortly,” Mulvaney said. White House aides and administration officials—including HHS Secretary Alex Azar and Seema Verma, CMS administrator—huddled at the historic Maryland property on Saturday to discuss the general path forward for President Trump’s health care policy, White House aides said. The talks ranged from messaging strategies to lowering drug prices to individual health insurance marketplaces.
On Tuesday, Americans for Tax Reform held a Capitol Hill briefing on the Department of Health and Human Services (HHS) proposal to subject Medicare Part B drugs to an “International Pricing Index” (IPI).
As ATR has written extensively, the IPI payment model will effectively import foreign price controls into the United States, lowering quality and access to lifesaving medicine. In November, ATR led a coalition of 56 conservative groups in opposition to the IPI.
ATR President Grover Norquist opened the panel by highlighting the effects of the proposal on trade, saying: “Under this rule, every time we win on trade, the administration would have to raise drug prices on Americans. This is a truly bad idea.”
“If the Supreme Court rules that Obamacare is out,” President Donald Trump said last week, “we’ll have a plan that is far better than Obamacare.”
A look at his fiscal year 2020 budget shows that the president has a plan to reduce costs and increase health care choices. His plan would achieve this by redirecting federal premium subsidies and Medicaid expansion money into grants to states. States would be required to use the money to establish consumer-centered programs that make health insurance affordable regardless of income or medical condition.
The president’s proposal is buttressed by a growing body of evidence that relaxing federal regulations and freeing the states to innovate makes health care more affordable for families and small businesses.