Healthcare in the Age Of Donald Trump and Thomas Price ACA: What’s Next? Healthcare in the Age Of Donald Trump and Thomas Price

DISCLAIMER NO ONE CAN SPEAK WITH CERTAINTY….EVER... RE HEALTH CARE TSUNG-MEI CHENG’S 3 UNIVERSAL LAWS OF HEALTH CARE: 1. NO MATTER HOW GOOD THE HEALTH CARE IN A PARTICULAR COUNTRY, PEOPLE WILL COMPLAIN ABOUT IT. 2. NO MATTER HOW MUCH MONEY IS SPENT ON HEALTH CARE, THE DOCOTRS AND HOSPITALS WILL ARGUE THAT IT IS NOT ENOUGH. 3. THE LAST REFORM ALWAYS FAILED.

Dr Thomas Price Eliminate “government interference” w healthcare Health Care Providers (Doctors & Hospitals) Determine How Much to Charge as “Medicare Plus” Health Care Providers Determine What Services to Provide as “Essential Health Benefits” “There are 1,442 citations in ACA where it says “The Secretary shall…” or “The Secretary may...” At HHS, we’ll look at every single one.” --- Tom Price “tweet”

What Drives Health Care Changes? “…the artificially inflate costs of health care are powering up inequality by producing large fortunes for a few while holding down wages; the pharmaceutical industry alone had 1400 lobbyists in Washington in 2014. American health care does a poor job of delivering health, but is exquisitely designed as an inequality machine, commanding an ever-larger share of the G.D.P., and funneling resources to the top of the income distribution.” Economic Sciences Nobel Prize 2015 Winner Angus Deaton

Continued Taxes Cadillac/Chevy Tax remains in place for 2020 All mandates & “fees”/taxes remain in place “Insurance” tax remains Fees & penalties for reporting violations still in place

New “Market Stabilization Rules” Shorten enrollment into Exchanges from 11/1 through 1/31 2016 to 11/1 through 12/15 2017 Require “verification” documentation to enroll in Exchanges Allow denial of coverage if non-payment during last year Allow actuarial values of plans to vary more (Silver from 66% to 72% Network adequacy on a state-determined basis

Rates for 2018 Determination Extended time to develop premiums from May 3rd to June 21st All remains uncertain until mid June and then 6 weeks of enrollment in November and December Less time to understand what is available All decisions made before new year even begins

Mix, Match, and Mangle By Possible Regulatory Changes (1) Individual insurance market End the cost-sharing payments to insurers. Narrow the essential health benefits rule. Refuse to settle the risk corridor litigation. Change the rules governing risk adjustment. Reduce reinsurance payments to insurers. Expand or curtail hardship waivers from the individual mandate

Possible Regulatory Mangling (2) Decline to enforce the individual mandate. End the “like it, keep it” fix. Alternatively, expand the “like it, keep it” fix to exempt a wider range of plans from insurance rules. Limit special enrollment periods. Reduce insurer assessments for participating on HealthCare.gov. Make it easier for online brokers like eHealthInsurance to sell subsidized coverage.

Possible Regulatory Mangling (3) MEDICAID Allow work requirements, premiums, and more cost-sharing under 1115 waivers. Allow states to limit how long beneficiaries can be continuously enrolled in the program under 1115 waivers. Permit more states to use Medicaid dollars to subsidize private exchange coverage. OTHER Expand the reach of the contraceptive mandate accommodation (currently available to religious nonprofits and closely-held for-profit companies). Striking contraception from the list of women’s preventive services, or eliminating women’s preventive services altogether. Delay enforcement of the employer mandate.

Possible Regulatory Mangling (4) Delay enforcement of taxes on the insurance, pharmaceutical, and medical-device industries. Delay enforcement of the Cadillac tax in 2020. Adjust the guidelines for 1332 waivers. Adopt rules under section 1333 to enable more flexible cross-state insurance sales. Pull the plug on mandatory (or voluntary) demonstration projects through the Innovation Center. Curb nondiscrimination protections, which the Obama administration interpreted to cover gender identity.

House v Burwell USDCt Judge Rosemary Collins says subsidy payments are not authorized by Congress Enjoined payments & then stayed ruling for appeal If US drops appeal – end of subsidies at Exchanges Slow Motion Collapse of Exchanges? “Death Spiral”?