Sen. Rand Paul unveils ACA replacement plan
Jan. 27, 2017
Another blueprint for replacing the Affordable Care Act has entered the mix. Sen. Rand Paul (R-Ky.) has introduced his version of a replacement called the Obamacare Replacement Act. Sen. Paul’s plan would remove the individual mandate and the minimum standards of care. It would also allow people with pre-existing conditions to sign up for care for two years ― although it is unclear what would happen to those individuals after two years. Sen. Paul’s plan would also provide a $5,000 tax credit that could be placed in a health savings account, and would allow insurers to sell health plans across state lines. His plan does not include a provision that would allow people under the age of 26 to remain on their parents’ health plans.
President Trump reiterates call for swift action on ACA repeal
Jan. 26, 2017
At the Republican party’s annual retreat in Philadelphia, President Donald Trump called on Republicans to take swift action on repealing the Affordable Care Act, stating that Congress has “no choice. If we waited two years, it’s going to explode like you’ve never seen an explosion.” President Trump did not offer details on his thoughts about what an ACA replacement plan should look like. However, in recent comments he has promised "insurance for everybody."
Speaker Ryan sets deadline for Obamacare repeal, replacement
Jan. 26, 2017
Speaking at the Republican party’s annual retreat in Philadelphia, House Speaker Paul Ryan stated that Republicans will repeal and replace pieces of the Affordable Care Act by the spring. Rep. Ryan said that his colleagues could expect several House committees to deliver a reconciliation package in the next several weeks and that the final reconciliation package will be on the House floor by late February or early March.
President Donald Trump is heading to Philadelphia to address the GOP and it is expected that he will offer details on his thoughts about ACA replacement options.
GOP heads to Philly to talk ACA repeal
Jan. 25, 2017
Congressional Republicans are heading to Philadelphia for their annual retreat to discuss a broad policy agenda. High on the list of topics to discuss will be how Republicans can repeal and replace the Affordable Care Act without hurting Americans who currently have coverage under the law. Shortly after the retreat, lawmakers will hold hearings and draft legislation that would repeal and replace the ACA. The House Budget Committee will hold a hearing on Jan. 31, titled "The Failures of Obamacare: Harmful Effects and Broken Promises.” The House Ways and Means Committee will also begin examining the 'effectiveness of the individual mandate.'
Per the recently passed fiscal 2017 budget resolution, the Senate Finance and Health, Education, Labor and Pensions Committees and the House Energy and Commerce and Ways and Means Committees have been tasked with drafting budget reconciliation bills that would include details on repealing the ACA by Jan. 27. However, it is unlikely that the committees will meet the deadline.
Dr. Price discusses ACA, regulatory burdens, transparency, and drug prices in nomination hearing
Jan. 24, 2017
Rep. Tom Price, MD (R-Ga.) ― President Trump’s pick for secretary of the Department of Health and Human Services (HHS) ― sat before the Senate Finance Committee, which will determine if his nomination proceeds to a confirmation vote, and answered questions about several health care issues.
Affordable Care Act
Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee, referenced President Trump’s executive order that directs the secretary of HHS to work toward the swift repeal of the ACA. Sen. Wyden asked Dr. Price if he could assure that no one citizen will be worse off if the ACA is repealed? Dr. Price committed to working with Congress to ensure access to high-quality care. Piggybacking off of Sen. Wyden’s question, Sen. Sherrod Brown (D-Ohio) asked if Dr. Price would enforce the ACA’s ban on discriminating against patients with pre-existing conditions or patients with illnesses that are expensive to treat. Dr. Price responded, “Nobody ought to lose their insurance because they get a bad diagnosis.”
Sen. Pat Roberts (R-Kan.) asked what tools Dr. Price will utilize to provide stability and improve the individual insurance markets to make them more appealing so that insurance carriers will want to come back? Dr. Price stated, “This law isn’t working. It’s not working for patients. One of the goals I have is to lower the temperature in this debate.” He indicated that government should assure carriers that the replacement plan will be more attractive to insurers.
When asked by Sen. Richard Burr (R-N.C.) what his overall goals are for an ACA replacement plan, Dr. Price reiterated his desire to provide accessible and affordable coverage for high quality care while offering patients choices.
CMMI
Sen. Orrin Hatch (R-Utah), chair of the Senate Finance Committee, asked Dr. Price about his thoughts on the Center for Medicare and Medicaid Innovation (CMMI) ― the agency under CMS that develops and tests value-based payment models. “Innovation is so incredibly important to health care and the vibrant quality of health care that we need to be able to provide to our citizens,” Dr. Price said. “One of the roles that we as policymakers have is to incentivize innovation. The Center for Medicare and Medicaid Innovation is a vehicle that might do just that. I think, however, that CMMI has gotten off track a bit. I think that what it has done is defined areas where it has mandatorily dictated to physicians and other providers in this country in certain areas how they must practice. I’m a strong supporter of innovation but I hope that we can move CMMI in a direction that actually makes sense for patients.”
Regulatory burdens
Sen. Roberts referenced various regulations, such as meaningful use, that have caused undue burdens on providers and asked Dr. Price how he will work to alleviate the burden. In response, Dr. Price agreed stating that, “The regulatory scheme that we’ve put in place is choking the individuals that are actually trying to provide care. So much so that you have physicians and other providers who are leaving the practice. The meaningful use project makes it that much more difficult. We’ve turned physicians into data entry clerks.” Dr. Price went on to say that recognizing the problem is the first step and then government must take a second look at the consequences of what it has done.
Transparency: Quality and cost
Sen. Pat Toomey (R-Pa.) asked Dr. Price about his opinions on transparency in health care, to which Dr. Price stated firmly that quality and cost information regarding care should be available to patients. “Outcomes are important and we need to be measuring what makes sense from a quality standpoint and allow patients and others to see what those outcomes are,” Dr. Price said. “But it’s transparency in pricing as well. If you’re an individual and want to know what something costs, it’s virtually impossible to find out what that is. If we want to make the system patient-friendly, not insurance-friendly or government-friendly, then we would make that a priority.”
Drug pricing
With regard to access to medications, Sen. Wyden asked Dr. Price if he would be willing to follow President Trump’s recommendation and allow federal health care plans the authority to negotiate drug prices. In response, Dr. Price said, “Right now the PBMs [pharmacy benefits managers] are doing that negotiation. It’s important to have the conversation and look at whether or not there’s a better way to do that. If there is, then I’m certainly open to it.”
In addition to a litany of questions on various health care related issues, several members of the committee reiterated concerns about the ethics of Dr. Price’s investments in various health-related companies while supporting bills that could have benefited these companies. The Senate Finance Committee will vote on Dr. Price’s nomination within the next several weeks.
GOP senators introduce new ACA repeal, replace legislation
Jan. 24, 2017
Sens. Susan Collins (R-Maine), Bill Cassidy, MD (R-La.), Shelley Moore Capito (R-W.V.), and Johnny Isakson (R-Ga.) have introduced the Patient Freedom Act (PFA) of 2017, which would repeal and replace the Affordable Care Act (ACA). The bill would repeal the individual and employer mandates but would retain several ACA consumer protections, such as the prohibition of discriminating against patients with pre-existing conditions. It would also allow young adults to remain on their parent’s insurance plan until age 26. The PFA also gives states the authority to choose one of three options: re-implement the ACA; choose a new state alternative; or design an alternative solution without federal assistance.
President Trump issues executive order to repeal ACA
Jan. 21, 2017
Merely hours after swearing in as the 45th President, Donald Trump signed an executive order calling for the swift repeal of the Affordable Care Act (ACA). President Trump’s executive order stated that in the interim, the law must be upheld. However, he called on his Administration to take steps to minimize the fiscal and regulatory burden of the law on citizens, providers, states, insurers, and other healthcare stakeholders by delaying or waiving any new regulation required under the ACA.
While the executive order does not have any immediate impact on the ACA, it provides direction for Congress and agencies such as the Treasury Department and HHS to follow through on Trump's request for repeal.
NIH director to stay put
Jan. 20, 2017
Francis Collins, MD, PhD, will remain as the director of the National Institutes of Health (NIH) under the Trump Administration. However, it is unclear if Dr. Collins will remain in the position permanently. About 50 Obama appointees will remain under the Trump Administration to maintain continuity until President-elect Trump’s nominees are confirmed. Dr. Collins is a is a physician-geneticist and has served as the director of the NIH since 2009. He has garnered bipartisan support in Congress.
Dr. Price faces Senate HELP committee in nomination hearing
Jan. 18, 2017
The Senate Health, Education, Labor and Pensions (HELP) Committee held a nomination hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for secretary of the Department of Health and Human Services. The American Academy of Dermatology Association attended the hearing. Among several health care related issues that were addressed during the hearing, most notably Dr. Price was asked about his thoughts on a replacement for the Affordable Care Act (ACA), access to drugs, and regulatory burdens on physicians. Additionally, Dr. Price addressed concerns about his financial ties to a medical device company.
ACA replacement
When asked by Committee Chair Sen. Lamar Alexander (R-Tenn.) about Dr. Price’s goal for an ACA replacement plan, Dr. Price stated that health care needs to be affordable, accessible, high quality, and responsive to patients, offer incentives for innovation, and ensure choices are made by and preserved for patients. When asked about the timing of repeal and replace, he stated, “I think that one of the important things that we need to convey to the American people is that nobody is interested in pulling the rug out from anybody.” Dr. Price also expressed an interest in implementing high-risk pools and expanding the use of health savings accounts in a replacement plan to cover general health services.
Medicare drug price negotiations
Sen. Bernie Sanders (I-Vt.) asked Dr. Price if he would join him and Democrats in efforts to allow Medicare to negotiate drug prices and allows drugs to be imported from Canada. Without confirming his position on government price negotiations or importation, Dr. Price stated that the cost of drugs is a high priority for all Americans and he committed to working with Congress in addressing the drug pricing issue.
Regulatory burdens
Sen. Bill Cassidy (R-La.) asked Dr. Price for his thoughts on what the government can do to address the regulatory burden that physicians are experiencing with electronic health record (EHR) requirements, such as Meaningful Use. Dr. Price said that EHRs are important from an innovative standpoint because they allow patients access to their medical history. However, he said that the federal government’s role is to ensure interoperability between EHR systems. Additionally, he indicated that the government should work more closely with providers in determining the metrics that should be measured through these systems to improve quality. “If we truly worked with the providers and asked them what we should measure, I suspect that there are some very specific things we could use.”
Government authority in health care
Sen. Pat Roberts (R-Kan.) expressed his concerns about the increased authority of the Independent Payment Advisory Board (IPAB), the Centers for Medicare and Medicaid Innovation (CMMI), the U.S. Preventative Services Task Force (USPSTF), and the Patient-Centered Outcomes Research Institute (PCORI). Dr. Price stated his concerns about CMMI, indicating that the patient should be at the center of care and that health care treatments should not be dictated by government.
Questions on ethics
Committee Ranking Member Sen. Patty Murray (D-Wash.) and Sen. Elizabeth Warren (D-Mass.) questioned the ethics of Dr. Price’s ties to a medical device company. Recently, information has been released about Dr. Price’s personal investments and potential ties to his legislative actions. According to House records, in 2016 Dr. Price bought between $1,001 to $15,000 worth of shares in Zimmer Biomet ― a knee and hip implant manufacturer. Shortly after the purchase, Dr. Price introduced the HIP Act that would have delayed a CMS regulation that would hurt Zimmer Biomet financially. Zimmer Biomet's PAC also donated to Dr. Price's reelection campaign.
When questioned at the hearing, Dr. Price indicated that the trade in Zimmer Biomet shares in his broker-direct account was handled by a broker and also denied knowledge of nonpublic information when trading certain stocks. Sen. Orrin Hatch (R-Utah) asked, “Can you confirm that you have always followed the law relating to trading in stocks while serving as a member of Congress?” Dr. Price responded, “Everything that we have done has been above board, transparent, ethical, and legal. The Office of Government Ethics has looked at our holdings and given advice on what needs to be done in terms of divesting from certain stock holdings to make certain that there are no conflicts of interest. We have read those, agreed to those, and signed those. That document is online for everybody to see.” View Dr. Price’s public financial disclosure report and his ethics agreement.
The HELP Committee hearing is considered a courtesy hearing. A formal hearing before the Senate Finance Committee ― the committee that will vote on Dr. Price’s nomination ― is scheduled for Jan. 24.
Nomination hearing scheduled for OMB pick
Jan. 18, 2017
The Senate Budget Committee has announced that it will hold a hearing on the nomination of Rep. Mick Mulvaney (R-S.C.) ― President-elect Donald Trump’s pick for director of the Office of Management and Budget ― on Jan. 24. A formal hearing for Dr. Tom Price's nomination as HHS secretary before the Senate Finance Committee ― the committee that will vote on Dr. Price’s nomination ― is also scheduled for Jan. 24.
In addition to helping prepare and administer the federal budget, OMB measures the performance of federal agencies, supervises and coordinates procurement, financial management, and information policies, and plays a role in the approval of major regulations that could significantly impact the economy. If confirmed, Mulvaney would be involved with expected efforts to roll back the Affordable Care Act (ACA) and other reforms implemented by the Obama Administration.
U.S. House votes to begin ACA repeal process
Jan. 13, 2017
The U.S. House of Representatives has voted 227-198 for a budget resolution that tasks several committees with drafting budget reconciliation bills that would include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. The budget resolution was recently approved by the Senate, so the appointed committees can now begin drafting reconciliation legislation.
Speaker Ryan: Expect action on ACA within first 100 days
Jan. 12, 2017
House Speaker Paul Ryan (R-Wis.) says that he anticipates action on repealing and replacing the ACA within the first 100 days of President-elect Donald Trump's term. Speaker Ryan discussed the fate of the ACA at a CNN Town Hall meeting at George Washington University. In addition to discussing a timeline for repeal, he stated that a replacement for the health care law would likely provide coverage for patients with pre-existing conditions. Additionally, he indicated that the House Republican replacement plan would allow individuals to receive refundable tax credits to purchase a plan that's right for them, and that Health Savings Accounts would be a “critical piece” of an ACA replacement. Read more highlights from the Town Hall meeting.
President-elect Trump addresses ACA, drug prices in first press conference
Jan. 11, 2017
In his first press conference as President-elect, Donald Trump has restated his position that the Affordable Care Act (ACA) should be repealed and replaced as soon as possible. He stated, “We're going to be submitting, as soon as our secretary [Dr. Tom Price] is approved, almost simultaneously ― shortly thereafter ― a plan. It will be repeal and replace. It will be, essentially simultaneously.”
Additionally, President-elect Trump reiterated his position that Medicare should be allowed to negotiate drug prices. “We’re the largest buyer of drugs in the world, and yet we don't bid properly…were going to start bidding and were going to save billions of dollars over a period of time,” the President-elect said.
Click here to read a transcript of the press conference.
President-elect Trump picks VA lead
Jan. 11, 2017
President-elect Donald Trump has selected David Shulkin, MD, to serve as secretary of the Department of Veterans Affairs. Dr. Shulkin ― trained in internal medicine ― was nominated by President Barack Obama in 2015 to serve as the undersecretary of the U.S Department of Health and Human Services.
In previous media interviews, Dr. Shulkin has indicated that he is in favor of offering a mixed care model for veterans ― where the VA would provide services such as treatment for post-traumatic stress disorder and the private sector would offer veterans other services such as obstetrics and gynecology.
Senate takes another step toward ACA repeal
Jan. 11, 2017
The Senate has voted 51-48 for a budget resolution that tasks several committees with drafting budget reconciliation bills that would include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. The budget resolution must now be approved by the House of Representatives before the appointed committees can begin drafting reconciliation legislation.
ACA repeal: Some Republicans ask for more time
Jan. 10, 2017
While Congress appears to be moving forward on ACA repeal, several members of the GOP are raising concerns about repealing the law without a comprehensive replacement strategy. The House Freedom Caucus is calling for more information on what repeal and replacement would look like before voting on the 2017 budget that would include includes Obamacare repeal instructions. “We need to slow down the process so we can understand a little bit more the specific and timetable of replacement votes and reconciliation instructions, etc.," said Freedom Caucus Chairman Mark Meadows (N.C.).
Additionally, Republican Sens. Bob Corker (Tenn.), Rob Portman (Ohio), Susan Collins (Maine), Bill Cassidy (La.) and Lisa Murkowski (Alaska) have filed an amendment that would extend the deadline for congressional committees to pull together a repeal and replacement plan ― via the budget reconciliation process ― from Jan. 27 to March 3. "By providing more time to come up with legislative solutions, we have a better opportunity to produce a thoughtful, workable replacement that ensures Americans have access to affordable, diverse insurance plans that meet their needs," Sen. Collins said in a statement.
The Senate is expected to vote on budget resolution amendments this week. It is unclear if the Senators’ filed amendment or the Freedom Caucus’ concerns will have an impact on the timing of the repeal and replace process.
Indoor tanning tax: Should it stay or should it go?
Jan. 9, 2017
As members of Congress inch closer to repealing the Affordable Care Act (ACA), questions remain on whether or not to repeal the taxes implemented as part of the law. There are roughly 21 new or increased taxes folded into the ACA ― including the 10 percent excise tax on indoor tanning. The debate hinges on whether Congress should scrap the entire bill including all the taxes ― leaving little revenue in place to cover the subsidies for those insured under the ACA until a replacement plan is put in place ― versus keeping the taxes in place for a larger tax reform effort down the road.
Congress appoints new E&C Health Subcommittee leader
Jan. 6, 2017
House Energy and Commerce Committee Chair Rep. Greg Walden (R-Ore.) has announced that Rep. Michael Burgess, MD (R-Texas) will serve as the leader of the House Energy and Commerce Health Subcommittee. The Health Subcommittee will play a large role in repealing and replacing the Affordable Care Act (ACA). The subcommittee also manages issues related to the CHIP program and FDA user fees.
Read more about Rep. Burgess’s thoughts on the ACA in the October issue of Dermatology World.
The fate of indoor tanning restrictions
Jan. 6, 2017
The House Freedom Caucus ― made up of roughly 35 Republican members of Congress including Rep. Mick Mulvaney (R-S.C.), President-elect Donald Trump’s pick for director of the Office of Management and Budget ― has issued a list of 200 rules and regulations that President-elect Trump should remove within his first 100 days in office. Item 74 on the Caucus’s list of regulations to remove is the “restricted use of sunlamp products” which the Caucus estimates would cost $1.126 billion. Read more about this regulation.
House Republicans introduce Obamacare replacement plan
Jan. 5, 2017
While repeal efforts for the Affordable Care Act (ACA) are well underway, several members of Congress are honing in on possible replacements for the law. The Republican Study Committee (RSC), led by its chairman Rep. Mark Walker (R-N.C.) and Phil Roe, MD (R-Tenn), has introduced a new replacement plan, the American Health Care Reform Act. This proposal would expand the use of health savings accounts, allow insurance companies to sell plans across state lines, and would issue block grants to Medicaid programs. The bill calls for a full repeal of Obamacare starting on Jan. 1, 2018, though it does not set a timeline for replacement.
The plan is similar to House Speaker Paul Ryan’s (R-Wis.) A Better Way plan in that it would provide coverage for people with pre-existing conditions and supply states with funding to establish high-risk pools. However, the RSC’s American Health Care Reform Act would create tax deductions ― $7,500 for an individual and $20,500 for married couples ― if they purchase a qualified health plan. Speaker Ryan’s A Better Way plan, on the other hand, would allow people to receive tax credits to purchase coverage.
Over the next several months, it is likely that the RSC’s plan will be one of several replacement proposals issued by the GOP.
Senate moves closer to repealing pieces of Obamacare
Jan. 5, 2017
In the first official step toward repealing the health care law, the U.S. Senate voted 51-48 to begin consideration of Senate Budget Committee Chairman Mike Enzi's (R-Wyo.) budget resolution that tasks several committees with drafting budget reconciliation bills that would include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. Under congressional budget rules, Congress could remove certain provisions under the ACA through this budget reconciliations process, requiring only a simple majority for passage, as opposed to a full repeal that would require a super majority.
Next week, votes are expected in the Senate on budget resolution amendments, with Democrats reportedly planning to propose amendments supporting various provisions of the ACA. Once the resolution clears the Senate, the House of Representatives is expected to swiftly consider the measure.
Rep. Black steps in for Dr. Price at House Budget Committee
Jan. 4, 2017
House Speaker Paul D. Ryan (R-Wis.) has announced that Rep. Diane Black (R-Tenn.) will serve as interim chair for the House Budget Committee ― stepping in for Rep. Tom Price, MD (R-Ga.) as he goes through the confirmation process for Secretary of the U.S. Department of Health and Human Services. If Dr. Price is confirmed, the House GOP Steering Committee would name a permanent chair ― a position that, as interim chair, Rep. Black would likely assume. If Dr. Price is not confirmed, he could return as chair.
The House Budget Committee would be heavily involved in the repeal of various pieces of the Affordable Care Act through the budget reconciliation process. “As interim Chairman for the House Budget Committee, I am ready to work with my colleagues on both sides of the aisle to repeal this law that has burdened families and businesses and turn the page to a new healthcare system that lowers costs, spurs free market competition, and ultimately empowers patients — not Washington bureaucrats,” Rep. Black said.
New Congress, new ACA repeal efforts
Jan. 3, 2017
It’s the first day of the 115th Congress, and several members are hitting the ground running on their promise to repeal the Affordable Care Act (ACA). Vice President-elect Mike Pence is scheduled to visit Capitol Hill this week to discuss repeal and replacement options with House Republicans. Meanwhile, President Obama will meet with Democratic members to discuss efforts to avoid repeal of the ACA.
Under congressional budget rules, Congress could remove certain provisions under the ACA through a process called budget reconciliation that requires only a simple majority for passage. Senate Budget Committee Chairman Mike Enzi (R-Wyo.) has introduced a budget resolution that provides reconciliation instructions to the Senate Finance and Health, Education, Labor and Pensions Committee as well as the House Energy and Commerce and Ways and Means Committees. Each committee is tasked with finding at least $1 billion in deficit reduction from fiscal 2017 through fiscal 2026, and to draft a reconciliation bill by Jan. 27. These bills will include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. Once crafted, the committees’ reconciliation bills will be combined for consideration in the House and the Senate.
Under House rules, the House of Representatives will be able to pass repeal with a simple majority vote, but Senate rules, which require 60 votes to end debate, could complicate ACA repeal efforts in that chamber where Republicans currently hold 52 of the 100 U.S. Senate seats. Democrats hold 46 seats, with the other two seats being held by independent senators who caucus with Democrats.
Tentative hearing scheduled for Dr. Price nomination
Jan. 3, 2017
The Senate Health, Education, Labor and Pensions Committee has set a tentative date for a hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for Secretary of the U.S. Department of Health and Human Services ― on Jan. 18. However, the hearing date will not be officially announced until one week before it is definitively scheduled to occur. This is would be a courtesy hearing, as it is the Senate Finance Committee that will ultimately vote on the nomination.
The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.
Similarly, Seema Verma, President-elect Trump’s choice for CMS administrator, can anticipate a confirmation hearing in the near future. Although a date for her hearing has not been publicly floated, the Senate Finance Committee indicates that it has received three years of tax returns and completed questionnaires from both Dr. Price and Verma.
President-elect Trump picks budget director
Dec. 21, 2016
President-elect Donald Trump recently nominated Rep. Mick Mulvaney (R-S.C.) to serve as director of the influential Office of Management and Budget (OMB). In addition to helping prepare and administer the federal budget, OMB measures the performance of federal agencies, supervises and coordinates procurement, financial management, and information policies, and plays a role in the approval of major regulations that could significantly impact the economy. If confirmed, Mulvaney would be involved with expected efforts to roll back the Affordable Care Act (ACA) and other reforms implemented by the Obama Administration. He also would be tasked with helping the President-elect keep his promise to maintain a moratorium on new federal regulations.
Before entering politics, Mulvaney was a private-practice lawyer and a businessman. He was elected to the South Carolina House in 2006, and to the U.S. House of Representatives in 2010.
President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January.
ACA replacement: A question of 'when?'
Dec. 20, 2016
While Congress and President-elect Donald Trump have vowed to repeal the Affordable Care Act (ACA) out of the gate in 2017, the timing for replacing Obamacare is still up for discussion. The two primary issues at hand: how long will the 20 million Americans enrolled in an ACA insurance plan need to find a suitable replacement, and how long will insurance companies need to create and price new plans? Members of the House Freedom Caucus are hoping for a six-month transition period, insurance companies are indicating that 18 months may be more manageable, and some sources say Obamacare may remain in place for at least four years after repeal. Regardless of replacement timing, repeal efforts are likely to move fast when the 115th Congress and President-elect Trump are sworn in.
What’s next for compounding?
Dec. 19, 2016
The American Academy of Dermatology Association (AADA) recently joined 16 organizations representing physicians, patient advocates, pharmacists and other health care providers in sending a letter to the transition team of President-elect Donald Trump regarding patients’ access to compounded medications. This comes as the U.S. Food and Drug Administration (FDA) considers finalizing compounding guidance documents which could limit compounding where the drug is considered a copy of a drug that is commercially available.
The letter expresses concern about the FDA’s implementation of the Drug Quality and Security Act (DQSA). It reads: “During a time of rising drug prices and increasing shortages, it is paramount that patient access be preserved for compounded medications. We are concerned that the FDA is implementing the DQSA in a way that is negatively impacting patient access to medications and subjecting state-licensed compounding pharmacies to FDA oversight and manufacturer standards in a way that exceeds the authority given to the Agency by Congress.”
In addition to asking that the new Administration consider rescinding these guidance documents, should the FDA proceed with finalizing them, the letter also offers ongoing assistance on these important issues to the transition team and the Trump Administration’s still-forming health policy team.
It is not clear where President-elect Trump stands on the FDA’s draft compounding guidance. Click here to read more about the guidance documents and learn how you can voice opposition to these restrictions.
Cures, drug pricing, and the next Administration
Dec. 14, 2016
Yesterday afternoon at the White House, joined by Vice President Joe Biden and key lawmakers from both parties, President Obama signed into law the 21st Century Cures Act, which makes new advancements in medical research and seeks to accelerate the approval of new drugs and treatments for patients. “It is wonderful to see how well Democrats and Republicans in the closing days of this Congress came together around a common cause,” said the President at the official signing ceremony. “I think it indicates the power of this issue and how deeply it touches every family across America.”
Among the federal agencies tasked with implementing the 21st Century Cures Act is the National Institutes of Health (NIH), which will see an increase in funding. Francis Collins, MD, PhD, a physician-geneticist, currently heads up the medical research agency. While President-elect Trump has yet to announce his picks of whom he wants to lead the Food and Drug Administration and the NIH, several key Republicans have expressed their support for keeping Collins on board.
The 21st Century Cures Act was applauded by many as it made its way through Congress and to the President’s desk for signature. However, additional actions are expected in the coming months in order to help address escalating drug prices. Barbara Greenan, senior director of Advocacy and Policy at the AADA, said the AADA “…looks forward to working with the new Administration and Congress on addressing this highly impactful issue in the context of other health system reforms.”
What's next for telemedicine?
Dec. 12, 2016
While traditionally thought of as an issue supported by congressional Democrats, congressional Republicans are increasingly warming to telemedicine as a means to provide health care. Additionally, “Donald Trump has indicated his support of utilizing telemedicine to increase access to care for veterans,” Mathy said. “We’re now seeing more bipartisan work on this issue. The question of whether or not legislation on telemedicine will garner Republican support boils down to cost and budget neutrality.”
So what can be expected from the new Congress in terms of telemedicine legislation? While still unclear, Mathy says that there is hope for some reiteration of the CONNECT for Health Act in the 115th Congress. The legislation ― introduced in the 114th Congress ― would create a volunteer program within Medicare for telemedicine and would allow reimbursement for store-and-forward and live-interactive technology. The AADA has expressed its support for this bill, which reflects the AADA’s position statement suggesting that state licensure law where the patient lives rather than where the physician is located should govern telehealth encounters. “This piece of legislation is the most agreed-upon telemedicine legislation that has garnered support across the aisle. However, “It will all come down to cost, and the Congressional Budget Office (CBO) still has not scored the CONNECT for Health Act.”
Additionally, in the 114th Congress, there was broad bipartisan support for the CHRONIC Care Act that includes two sections related to telemedicine. “One section would allow Medicare Advantage plans to provide additional telemedicine services as a supplemental benefit,” Mathy said. However, patients would be allowed to choose if they would prefer a telemedicine visit over in-person. “The other section would remove the geographic location requirement in Next Generation Accountable Care Organizations, which would allow chronic care patients to receive services from their home. Currently, the geographic location or originating site has to be a health care office or clinic.” Although it was introduced in the 114th Congress, the CHRONIC Care Act is set to be re-introduced early in the new Congress.
Regardless, Congress and the new Administration will likely have its hands full as it looks to repeal and replace the ACA. “A lot of time in the health care space will be spent on ACA repeal and replacement,” Mathy said. As a result, telemedicine may sit on the back burner until larger issues are addressed.
Tackling drug prices
Dec. 7, 2016
Congress has passed the 21st Century Cures Act, legislation that will provide funding for the U.S. Food and Drug Administration (FDA) to accelerate the drug and medical device approval process. The legislation will also provide funding for basic, translational, and clinical research. The legislation is deemed by many as a means to quell the rising cost of drugs by encouraging more drugs to enter the market more quickly. However, additional efforts to address this issue are likely when the new Administration and Congress take over, and according to Barbara Greenan, senior director of Advocacy and Policy at the AADA, they will be multifaceted. “Certainly, expediting the backlog of generic drug approvals at the FDA is one way to drive down drug prices. However, this issue is complex and the new Congress and Administration will have to work with all stakeholders to find solutions that ensure patients have access to effective treatments.”
Specifically, several members of Congress are looking to alleviate the drug pricing issue by granting Medicare the authority to negotiate drug prices with manufacturers. “This is a concept that Democrats have largely supported and that President-elect Trump supported while on the campaign trail, but congressional Republicans generally oppose it,” said Christine O’Connor, AADA associate director of congressional policy.
Another option that has been kicked around is removing restrictions on drug importation. For example, in the 114th Congress, Sens. John McCain (R-Ariz.) and Amy Klobuchar (D-Minn.) introduced the Safe and Affordable Drugs from Canada Act. “President-elect Trump has indicated that he would support re-importation of drugs,” O’Connor said, “and there is some bipartisan support in Congress to do this. However, the pharmaceutical industry opposes re-importation.” Similarly, Congress may also turn the focus on the manufacturers and require more transparency into drug-pricing methods. “For example, in the 114th Congress, Sens. John McCain (R-Ariz.) and Tammy Baldwin (D-Wis.) introduced the FAIR Drug Pricing Act that would require drug manufacturers to explain price increases of more than 10 percent.” While these pieces of legislation will die at the close of the 114th Congress, similar legislation may be introduced next year in the new 115th Congress.
Of course, even if legislation passes muster in both chambers on the Hill and in the White House, the new Administration will likely be tasked with implementing these new laws. “There will be a heavy lift on the regulatory side to implement and operationalize drug pricing legislation,” Greenan said. “However, rising cost of drugs cannot be ignored and the AADA looks forward to working with the new Administration and Congress on addressing this highly impactful issue in the context of other health system reforms.”
Trump picks Cleveland Clinic CEO for advisory panel
Dec. 7, 2016
President-elect Donald Trump has selected a panel of private-sector leaders to help guide his economic and business policy choices. The President's Strategic and Policy Forum will include 16 noted business leaders, including the CEOs of Disney, General Motors, JP Morgan Chase, and Walmart. Of interest to medicine, Cleveland Clinic CEO Toby Cosgrove, MD, has been selected as a member of the panel. A cardiovascular surgeon by training, Dr. Cosgrove has led Cleveland Clinic's quality improvement efforts, including making same-day appointments available throughout the system. Under his leadership the system has been regularly named one of the top hospitals in the United States.
Congress names top Democrat for House W&M Committee
Dec. 6, 2016
Rep. Richard Neal (D-Mass.) has been selected as Ranking Member on the House Ways and Means Committee, which has jurisdiction over tax- and revenue-related issues. Specific to dermatology, the Committee would be responsible for addressing a repeal of the 10 percent indoor tanning tax, and would likely play a role in any efforts to reform Medicare and/or repeal and replace the Affordable Care Act.
As IPAB cuts loom, support for repeal grows
Dec. 2, 2016
Efforts to repeal the Independent Payment Advisory Board (IPAB) are gaining momentum as the threat of Medicare cuts appears increasingly likely. The IPAB was instituted as part of the Affordable Care Act and would task a 15-member panel of appointed officials with containing Medicare costs if costs exceed certain levels. If a board is not appointed, the Secretary of the U.S. Department of Health and Human Services would be responsible for making cuts. These cuts would only be overridden by a supermajority in the Senate (60 votes) ― a provision that members of Congress see as undermining congressional authority.
Currently, no members have been appointed to the IPAB board and spending has not yet exceeded the target at which recommendations would be required. However, current predictions indicate that spending in 2017 could trigger cuts in 2019.
Congress appoints new E&C chair
Dec. 1, 2016
While President-elect Donald Trump’s transition team is vetting members of the new Administration’s cabinet, on Capitol Hill, Rep. Greg Walden (R-Ore.) has been selected as the chair of the U.S. House Energy and Commerce Committee which has jurisdiction over issues concerning health care, and is the primary committee for addressing the Affordable Care Act, the Medicare Access and Chip Reauthorization Act (MACRA), compounding, drug pricing, and the 21st Century Cures bill that, if passed, would provide medical research funding. Rep. Walden will replace Rep. Fred Upton (R-Mich.), who has served in the role since 2010. Rep. Walden is the outgoing National Republican Congressional Committee chairman. According to his congressional website, he is in favor of repealing and replacing the Affordable Care Act and he also supported the 21st Century Cures Act.
President-elect Trump picks CMS administrator
Dec. 1, 2016
President-elect Donald Trump has nominated Seema Verma, president, CEO, and founder of SVC, Inc., a health policy consulting group, to serve as CMS administrator.
Verma helped create and update the Healthy Indiana Plan ― Indiana's consumer-directed Medicaid program ― under Gov. Mitch Daniels and Vice President-elect Gov. Mike Pence. Prior to her role at SVC, Verma served as vice president of planning for the Health and Hospital Corporation of Marion County in Indiana and director for the Association of State and Territorial Health Officials in Washington, D.C.
President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January.
President-elect Trump picks Dr. Price for HHS
Nov. 30, 2016
President-elect Donald Trump has nominated House Budget Committee Chair, Rep. Tom Price, MD (R-Ga.), to serve as Secretary of the U.S. Department of Health and Human Services.
Dr. Price, an orthopedic surgeon, has been a staunch supporter of the full repeal of the Affordable Care Act (ACA) ― he introduced the Empowering Patients First Act in 2015 which would fully repeal and replace the ACA with a system that includes individual health pools and expanded health savings accounts, and would have given physician groups control over performance-based quality measures. As a physician, Dr. Price has indicated that he understands the administrative burdens placed on the physician community and has expressed concerns over the burdens of electronic health records and Meaningful Use ― indeed, he was instrumental in the passage of a blanket hardship exemption from MU requirements in 2015. He also supports allowing physicians to balance bill their Medicare patients, repealing the Independent Payment Advisory Board (IPAB), allowing the use of in-office compounded drugs, preserving the In-Office Ancillary Services Exception to the Stark Law, and ensuring that step therapy protocols do not impede patient access to necessary treatment.
The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.
President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January. The AMA and other medical organizations have announced their strong support for Dr. Price's nomination.
What about the IPAB?
Nov. 29, 2016
There has been a massive political push to repeal and replace the Affordable Care Act, but how will it affect dermatology? While the American Academy of Dermatology Association (AADA) was concerned with the ACA when it was implemented, it redirected its focus to improving the law so that it does not undermine patients’ access to dermatologic care. Specifically, the AADA continues to call for repeal of the Independent Payment Advisory Board (IPAB) — instituted as part of the ACA — which consists of a 15-member panel of appointed officials that are tasked with containing Medicare costs if costs exceed certain levels. Currently, no members have been appointed and spending has not yet exceeded the target at which recommendations would be required. However, “Current predictions indicate that 2017 Medicare spending will trigger cuts in 2019,” said Michelle Mathy, assistant director of political and congressional affairs at the AADA.
According to Mathy, one major challenge in repealing the IPAB, however, is that Republicans will want to offset the cost of repeal — which has a price tag of about $13 billion. Coming up with such offsets has been one of the chief difficulties in passing legislation in recent years. Additionally, Trump has not specifically expressed an opinion either way on IPAB. If the full ACA is repealed, the IPAB would be repealed as well.
If the ACA is not repealed, the IPAB would have to be addressed on its own. If Republicans use the reconciliation process ― which gets around the 60-vote filibuster threshold and can only be used for legislation that affects the deficit ― things get complicated. “When the Republican Congress voted to repeal parts of the ACA under the reconciliation process last year, the Senate parliamentarian ruled that the provision to repeal IPAB violated the Byrd Rule which requires reconciliation bills to have a budgetary impact,” said Christine O’Connor, AADA associate director of congressional policy. “As a result of that ruling the provision was removed from the bill.” Essentially, the IPAB would have to be addressed and repealed in a separate bill ― a possibility given that repeal of the IPAB has garnered bipartisan support.
Read more about how the new Congress and Administration are likely to address these issues in the October issue of Dermatology World.
The fate of Obamacare
Nov. 28, 2016
The debate about repealing and replacing the Affordable Care Act (ACA), also commonly known as Obamacare, has raged since the controversial legislation was signed into law in 2010. Since then Republicans in Congress have voted to repeal all or parts of the law more than 60 times ― efforts that have died in the Senate or been vetoed by President Obama. “After nearly a decade of premium increases, Obamacare is sending premiums to new heights and despite all of the efforts folks must endure to obtain coverage, they often face further obstacles to gain access to care,” said Rep. Tom Price, MD (R-Ga.) — who will be nominated Secretary of the U.S. Department of Health and Human Services in the new Administration — in an interview with the Academy’s Dermatology World magazine. “Obamacare can’t be fixed; we must fully repeal it so we can start over with a new approach.”
However, now that Republican President-elect Donald Trump is headed to the White House, the controversial piece of legislation could be on its way out. Throughout his campaign, President-elect Trump has vowed to sign legislation that would fully repeal the ACA, and just recently, Vice President-elect Mike Pence has confirmed that full repeal will be one of the Administration’s top priorities, stating, “Decisions have been made by the president-elect that he wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free-market solutions that he campaigned on.”
In terms of replacement options, “Republicans would preserve some insurance market protections,” said Eric Cragun, senior director of The Advisory Board’s health care policy division, in a recent webinar. “They would likely cap tax exclusions for employers and expand HSAs.” Indeed, in a recent interview with the Wall Street Journal, the President-elect indicated that he would be open to keeping two provisions of the current law: the provision that would not allow insurance companies to deny coverage to patients with pre-existing conditions, and the provision that allows children to remain on their parents’ health plans through age 26.
Yet, repealing the law will require 60 votes in favor of repeal in the Senate and Republicans currently hold only 51 seats. Congress could remove certain provisions under the ACA through a process called budget reconciliation, however, “It’s a classic example of: it’s much easier said than done,” said Piper Su, vice president at McDermott Consulting, in a recent Advisory Board webinar. According to Su, the ACA provisions that could be repealed through the budget process would have to be significantly tied to federal fiscal policy. “The provision would have to have a big budget impact. It’s a fairly complicated maneuver, but they’d have to try because it’s hard to envision a world where they would get 60 votes to do an overall repeal.”
Read more about how the new Congress and Administration are likely to address these issues in the October issue of Dermatology World.