Advocacy in Action - A New Year and the Beat Goes On

Carter L. Alleman, J.D.

Happy 2017! The New Year will bring one of the most interesting years in healthcare policy.

The Affordable Care Act Repeal

Congress is set to begin, again, the repeal of the Affordable Care Act. This will be the first big task for Congress to tackle since the Republicans now have control of both chambers of Congress and the White House. The Senate and House of Republicans submitted budget bills following the reconciliation instructions to begin the repeal. The key caveat to reconciliation is that it can only be used to lower the deficit not raise it, so success will depend on the Congressional Budget Office scoring as well as legislative economic maneuvering. By going through the reconciliation process, a simple majority is needed in the Senate and there is no filibuster.

Besides the narrowness of the reconciliation process, Congress is also facing increased pressure from medical associations, insurance companies, and patient groups to stop the repeal process until a replacement plan is agreed on and present. Currently, the Republicans have not put together a replacement plan in a cohesive nature. There are many ideas including health saving accounts, allowing pre-existing conditions to be covered, and staying on parents’ insurance until 26 however these have not been formed into an actionable replacement plan.

The repeal legislation is expected to arrive on President Donald Trump’s desk in February 2017.

MACRA Now the Quality Payment Program

With the passage of Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA) and the repeal of the sustainable growth rate (SGR), a new payment program was promulgated, the Quality Payment Program which is now effective January 1, 2017. With the new Administration, potential changes could be on the horizon for the program under the guise of regulation relief. Potential changes include moving the effective date of the cost category in Merit-based Incentive Payment System (MIPS) until 2020 so that adequate time is given to the attestation modeling and how cost is calculated. The main argument is that no one quite knows how much any costs in healthcare and that for this category to work a baseline must be established. Another change is allowing the MIPS program to reweight categories based on participation ability rather than solid regulatory guidelines.

Graduate Medical Education

The House Ways and Means Committee is looking to cut funding for graduate medical education. There is a movement on the Hill to undo the single accreditation process through Accreditation Council for Graduate Medical Education (ACGME) and open the accreditation system up. The belief is that more than one accrediting body would create better opportunities. Those better opportunities have not been elaborated on, but it is the Committee’s belief that there are better ones available than the current model. Another avenue of cost cutting by the Committee is the ending of the public service loan repayment program. This program allows individuals with student loans to receive favorable repayment terms and discharge of debt following 10 years of public service. The Committee is working to narrow the definition of public service which will result in many professionals losing access to this program.  

D.O. Day on the Hill 2017

Changes are coming to healthcare policy. Changes that will change how the practice of medicine is conducted in and out of the doctor’s office. The best way to deal with change is to be part of the process. The American Osteopathic Association and the American College of Osteopathic Surgeons invite you to be part of this process at D.O. Day on the Hill 2017 on April 5, 2017 in Washington, D.C. I cannot stress enough how important it is for you to come advocate, share your stories and experiences with your members of Congress. D.O. Day on the Hill will provide you with the best opportunity to share your story with Congress. The ACOS and American Osteopathic Academy of Orthopedics is sponsoring a surgeons breakfast the morning of D.O. Day for all members who are attending.

D.O. Day on the Hill is April 5, 2017. Registration is available here. Registration closes February 24, 2017. Sign up today!