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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: • • • • 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: • • • • • 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 • • • • • • • • 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]