Healthcare Uncertainty Continues in Washington

Senate Democrats pulled off a surprise boycott of Tuesday’s meeting of the Senate Finance Committee, which was originally scheduled to finalize the nomination of Rep. Tom Price (R-Ga.), President Trump’s pick to helm the U.S. Department of Health and Human Services (HHS).

Senate Finance Committee Ranking Member Ron Wyden (D-Ore.), who led the boycott, said in a statement that unanswered questions and misleading statements by Price led to the delay in what was to have been the scheduled confirmation of the nominee. Wyden said that the issue hinged on the fact that Price had earlier testified that he did not receive an exclusive discount on purchases of stock for an Australian biomedical company. 

Today’s Committee meeting was expected to result in Price’s confirmation prior to it going to a full Senate vote. With the Democrats having boycotted the session, the meeting will be rescheduled. Ironically, the boycott came on the last day of 2017 open enrollment under Patient Protection and Affordable Care Act (PPACA).

“Rep. Price has been critical of (the) Centers for Medicare & Medicaid Innovation (CMMI),” Rhonda Taller said in an email to RACmonitor. “(Price) doesn’t like (the) mandatory bundles they (CMS) did for joint replacement and cardiac care.”  

Taller also said that the Advancing Care Coordination (ACC) program, managed through episode payment models (EPMs) and the Cardiac Incentive Payment Model Rehab Incentive Payment Program, are among regulations that fall under regulatory freeze announced by President Trump on Monday. This pilot is due to start July 1.

“Most people think CMMI will survive, but may look different (and) have (a) different name and more Congressional oversight,” Taller said. “All the Advanced Alternative Payment Models (A-APM) under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 come today from CMMI, so to get rid of CMMI equates to cutting off the A-APM track under MACRA’s Quality Payment Program (QPP) – or the other track, which is the Merit-based Incentive Program (MIPS).”

Taller says that there is consensus for keeping MACRA, noting that it did eliminate the flawed sustainable growth rate (SGR) formula for reimbursing physicians under Medicare. 

“MACRA passed in 2015 with (a) great deal of bipartisan, bicameral support, with Rep. Price voting for the program,” Taller said.

On the other hand, she noted, there is no consensus among Republicans for repealing and replacing the PPACA. 

Taller said that different pieces of legislation can be expected to be introduced, noting that already there is a discussion draft authored by Rep. Greg Walden (R-Ore.), who chairs the House Energy and Commerce Committee. The Walden draft would maintain coverage for preexisting conditions. 

“It’s unclear what the final Republican solution will look like,” Taller said. 

And so far, there has been no rescheduling of the Senate Finance Committee on the confirmation vote for Price.