After last week’s election results, there are many outstanding questions weighing on the minds of Americans. One of the most significant questions is, what will happen to the Affordable Care Act? However one refers to it, the Affordable Care Act, Obamacare, ACA, PPACA, changes are inevitable. In late October, President-elect Donald Trump released his “100-day action plan” for office which included “Repeal and Replace Obamacare”. With limited insight into what “repeal and replace” will entail, coupled with Speaker Paul Ryan’s latest statements which suggest that Medicare itself should be phased out, we are left to ponder pressing questions about what this will mean for the Healthcare Industry.
The biggest question is, will they truly “repeal and replace” the entire Patient Protection and Affordable Care Act (PPACA) or will it be limited to certain provisions of the Act? The final PPACA regulations are over 10,000 pages long and contain regulations on a wide range of healthcare related matters. The many topics covered by PPACA impact each player in the healthcare industry (provider, patient, insurance carrier, vendor, etc..) very differently.
Much of the PPACA was split into two separate areas: 1) Provider reform, and 2) Payer reform. While Payer reforms such as employer requirements, exchange premiums, the individual mandate and Medicaid expansion, have gotten the lion’s share of media and pundit attention, Provider reform has gotten little coverage. While perhaps not as exciting for major news outlets, many of the provider reforms have had significant positive impact on healthcare delivery including lower readmission rates, improved patient safety, mandated coverage for preventive care and pre-existing conditions and a reduced number of uninsured Americans. The mechanisms by which many of these accomplishments were achieved were critical components of PPACA, designed to reduce cost and improve quality. Repealing PPACA could turn back the clock on this progress. A perfect example is the CMS Innovation Center, created to test new payment models designed to improve quality and reduce cost. If the Innovation Center is repealed, it leaves many wondering, what will happen to the innovative new payment models currently in place like bundled payments and alternatives to fee-for-service reimbursement? Will these be repealed as well? The short answer is, we don’t know.
