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Connecticut Cancer Partnership
Cancer and Health Policy:
Post-Election Analysis and Implications
Matthew C. Katz, MS
EVP/CEO, Connecticut State Medical Society
December 6, 2016
Health Care Spending
According to the Health Care Cost Institute,
health care spending increased
• 4.6% in 2015
• 2.6% in 2014
• 3% in 2013
Utilization Trends
Decreased utilization
• Emergency department
• Surgical hospital admissions
• Primary care visits
Increased utilization
• Outpatient care
• Laboratory tests
• Specialty care
Insurance Mega-Mergers
• US DOJ suits to block Anthem-Cigna,
Aetna-Humana mergers
• Anthem-Cigna trial began 11/21
– Cigna CEO testified that Anthem was
“inaccurate” about merger benefits, potential
savings
• Aetna-Humana trial began 12/5
Affordable Care Act
After six years of the ACA:
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20 million additionally covered
Billions in premium subsidies
State, federal and mixed exchanges
Hundreds of Accountable Care
Organizations (ACOs)
Affordable Care Act
• High-deductible health plans
• Significant out-of-network deductibles
– Narrowed and tiered networks
– Reduced competition/mergers
• 55% increase in Medicare Advantage
enrollment
Affordable Care Act
ACA Post-Election: What Will Happen?
• Repeal
– Partial?
– Total?
• Replace
– With what?
• Likely an almost immediate attempt to
repeal and replace, but implementation
could take a year or more
Affordable Care Act
Likely to Remain
Likely to Go
Likely to Change
• Pre-existing condition coverage
(non-discrimination provisions)
• Coverage by parents until age 26
• Individual mandate
• Employer mandate
• Exchanges
• Funding
•Medicaid expansion/funding
Affordable Care Act
What comes next?
• Privatization of Medicaid?
• Great Unknowns
• All Payer Claims Databases (APCDs)
• State Innovation Model (SIM) funding
• Health Information Technology (HIT),
including Health Information Exchanges
(HIEs)
• COOPs
Affordable Care Act
ACA Cost Strategy
• Key element of the ACA cost control
strategy is part of Medicare and CHIP
Reauthorization Act (MACRA)
• CMS’s Center for Medicare and Medicaid
Innovation (CMMI)
MACRA
Medicare Access and CHIP Replacement Act 2015
• Strong
bipartisan, bicameral support
• Offers 2 paths for Medicare physician reimbursement
• Merit Based Incentive Payment System (MIPS)
• Alternative Payment Models (APMs) include
accountable care organizations (ACOs) and other
demonstrations
MACRA
A complete MACRA overhaul is unlikely: moving
from volume to value was (and remains) a goal
for Congress.
But…
• MACRA implementation could face hurdles if
Congress decides to repeal or constrain ACA
sections associated with CMMI
• Any limitation on CMMI could have a drastic and
detrimental impact on the ability to operate
demonstration projects
MACRA
• CSMS has developed a series of Medicare quality
webinars, including MACRA, under the auspices of the
New England Quality Innovation Network-Quality
Improvement Organization (QIN-QIO).
• The New England QIN-QIO is administered by
Healthcentric Advisors in partnership with Qualidigm.
Together, they serve as the QIN-QIO for all six New
England states.
• CSMS & the New England QIN-QIO will present
Demystifying MACRA, a live CME program on 12/12/16.
Medicare Changes
• Republicans may overhaul Medicare
• Paul Ryan plan: “voucherizing” Medicare premium
support for beneficiaries
– Shop on exchange-like structures, choose private plans
or traditional Medicare plans
• Trump transition website says one of the Presidentelect’s priorities is to “modernize” Medicare
• 2016 Medicare Trustees’ Report: Medicare
financially sound through 2018, an 11-year
improvement from pre-ACA forecast in 2009
Cancer Moonshot
• Not yet funded
– HIT budget Congress had increased 2017 HIT
budget $1.5 billion by the House Panel and $2
Billion by the Senate Committee a 7 percent
boost after the agency lost roughly 20 percent of
its resources between 2003 and 2015,
• NIH resources could be threatened
• Continuing resolution (CR) through Dec 9th
but need funding to continue
21st Century Cures Act
Highlights include:
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Innovation projects & state responses to opioid abuse
NIH Reauthorization
Advancing Precision Medicine
Patient-focused Drug Development
Advancing New Drug Therapies
Amended by the House and the Senate
• 1455 lobbyists representing 400 organizations pushed
for (and against) the bill
2016 Election
Winners
Stuck in the Middle
•Commercial insurers,
including Medicare
Advantage plans
•Drug companies, if
changes are made to
patents & FDA
timelines
Losers
• State budgets
Patients and
physicians
•Hospitals?
Trump Administration
Appointments
HHS Secretary Tom Price, MD
• Orthopedic surgeon from Georgia; active in organized
medicine
• As a US Representative (GA-06), voted for MACRA but
wants to streamline reporting requirements
• The AMA issued a statement strongly supporting Dr. Price for
the position
CMS Administrator Seema Verma
• President, CEO and founder of SVC, a national health policy
consulting company that has helped craft Medicaid
expansion plans in IN, IA, KY, MI & OH
Both appointments subject to Senate confirmation
Trump Healthcare
Transition Plan
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Replace ACA with solution that includes
Health Savings Accounts (HSA)
Resume states’ historic role in regulating health insurance
Re-establishment of high-risk pools
Medicare “modernization”
Maximal flexibility for state Medicaid programs
Allow individuals to purchase insurance across state lines
Reform the FDA to “put greater focus on the need of
patients for new and innovative medical products”
• Advance research and development in healthcare
• Protect “individual conscience in healthcare” and “protect
innocent human life from conception to natural death”
Trump Healthcare
Transition Plan
Regulatory Action
• Executive Order
– Can be used to pull back healthcare measures implemented by
President Obama that are not based in statute
• Rulemaking
• Sub-regulatory Guidance
• President-elect can “freeze” regulatory actions taken 60
days before he takes office
Legislative Action
• Budget Reconciliation Process
• Freestanding Legislation
Trump Healthcare
Transition Plan
Budget Reconciliation Process
• ACA provisions repealed through reconciliation only
require simple majority
• Reconciliation not subject to filibuster
• Reconciliation rules prohibit certain provisions from
being advanced, including
– Reconciliation cannot include provisions that do not
produce a change in spending/revenues
– Reconciliation cannot include provisions where the fiscal
impact is secondary to non-fiscal effects
Trump Healthcare
Transition Plan
ACA Provisions Included in Prior Reconciliation Bill:
• Premium tax credits and cost-sharing subsidies
• Individual and employer mandate
• Branded prescription drug tax
• Medical device tax
• Health savings account & flexible spending ccount tax
provisions
• Medicaid expansion provisions
• Prevention and Public Health Fund appropriations
• Small business tax credits
* These provisions were included in the 2015 Congressional Reconciliation
bill (H.R. 3762), which was vetoed by President Obama
Connecticut General
Assembly- Post Election
•2013-2015 Election Cycle
–Senate Democratic Control
22-16
–House of Representatives- Democratic Control
97-54
•2015-2017 Election Cycle
–Senate- Democratic Control
21-15
–House of Representatives- Democratic Control
87-64
•2017-2019 Election Cycle
–Senate Split
18-18
–House of Representatives- Democratic Control
79-74
Connecticut Action
• State Innovation Model (SIM) Activities
• Governor’s Healthcare Cabinet proposals
• Certificate of Need (CON) Task Force
Matthew Katz
EVP/CEO
Connecticut State Medical Society
[email protected]