Posted in Accountable Care, ACO, Affordable Care Act, TrumpCare

TrumpCare: As the Puzzle Emerges…

by Gregg A. Masters, MPH

As the Trump administration takes form via the nomination of Rep. Tom Price to ‘steward’ (or decimate) the massive bureaucracy of the Department of Health and Human Services (HHS) with Seema Verma nominated as Administrator of the Centers for Medicare and Medicaid Administration (CMS) the structural touch-points to manifest the ‘repeal and replace‘ agenda of the Affordable Care Act (ACA) may be materializing before our eyes.

medscape_physician_survey2016Dr. Tom Price a Board Certified Orthopedic Surgeon (Editor’s note: the highest paid specialty per Medpage 2016 physician compensation survey and according the the Georgia Combined Board of Medical Examiners a ‘non participant’ in Georgia’s Medicaid program, with zero reported hospital appointments, publications or settled professional liability claims) and a vocal opponent of the ACA with several bills sponsored to enable ACA’s repeal and replacement is no friend of Medicare, Medicaid nor the broader ecosystem enabling the fulfillment obligations of the U.S. healthcare ‘[non]system‘.

Much of this likely health policy directional pivot can be reasonably visioned though the lens of what’s emerging as indicia of ‘TrumpCare‘ – the probable repeal and replacement option for ‘ObamaCare‘ aka the ACA.

In order to drill into what we can expect from President-elect Trump and the leadership team he’s proposed to assemble in order to drive his presumptive health reform vision we need focus on Rep. Tom Price’s historical positions and statements as potential replacement options.

The umbrella policy framework for for what may emerge as ‘Trumpcare’ begins at ‘Great Again‘ the .gov website dedicated to the President-elect’s agenda, and informed viaA Better Way (aka RyanCare) the Republican version to substitute ‘Government controlled‘ healthcare with so-called ‘free market‘ alternatives.

[Editor’s Note: At the bottom of this post we list a series of recent links associated with relevant health reform conversations].

Perhaps the most useful insights as to what is likely to survive the political consideration process is sourced from the collection of Republican authored repeal and replace proposals sourced from the historical work of Representative Tom Price.

At a June symposium organized by the American Enterprise Institute (AEI), Rep. Price, who serves as Chair of the House Budget Committee previewed his vision of healthcare reform with the following summary statements:

‘the ACA violates all of the principles that all of us hold dear…. accessible, affordable, a system of the highest quality and a system that provides choices for the American people – for patients.’

‘What we have put together is a patient centered plan that respects those principles. That allows everybody to have access to the coverage that they want not what the government forces them to buy.’

‘To solve the insurance challenges of portability and pre-existing and to save hundreds of billions of dollars.’

‘A few specific examples I’d like to share with you…

‘the individual and small group market – those of you who recognize or are in that area [Editor’s Note: code-speak for special interest groups including brokers, agents, MGAs and underwriters] you appreciate that its been ‘destroyed’ [Editor’s Note via essential health benefits, no preexisting conditions, mandatory MLR ceilings, removal of lifetime caps and the individual mandate] and so we want to re-constitute that market and make it responsive to patients and allow them to purchase the kind of coverage that they want [Editor’s Note: via a return to ‘junk insurance’ and ‘mini-med’ policies] not what the government forces them to buy [Editor’s Note: on the exchanges or via ACA sanctioned group health policies].’

‘Second we waste hundreds of billions of dollars [Editor’s note: estimated at a $55.6 Billion Price Tag Large, But Not a Key Driver of Total Health Care Spending] …due to lawsuit abuse in this country, the practice of defensive medicine and instead of just putting a band-aid on it, we propose a bold and robust solution that would allow physicians through practice guidelines [Editor’s note: Evidence Based Medicine, or so-called “cookbook medicine” by the AMA] to basically have a “safe harbor” [Editor’s note legal CYA] if your doctor does the right thing for a given diagnosis or given set of symptoms then they ought to be able to use that as an affirmative defense in a court of law – that’s the kind of proposal that we put forward.’

‘And third in addition the healthcare system that works for patients is one the must respect the physician patient relationship [Editor’s note: typically third party disintermediated practice, i.e. direct practice, concierge medicine, retainer or membership models] and so what we do is incentivize the highest quality of care without bureaucratic intervention. This better way, this plan right here that puts forward positive commonsense solutions for Medicare, Medicaid and for the larger healthcare arena so that we respect the principles of accessibility, of affordability of quality and of choices…’

There is so much fluff here we decided to do a deep dive on ‘PopHealth Week‘ with healthcare thought leaders and former health system and JV enterprise operators Fred Goldstein, Douglas Goldstein and Gregg Masters. We weighed in on some of the provisions of Representative Price’s tantalizing offers to the American people to deliver a viable alternative to the ACA that:

‘allows everybody to have access to the coverage that they want not what the government forces them to buy;

solves the insurance challenges of portability and pre-existing; and

saves hundreds of billions of dollars.’

You be the judge! Or as some may be recently awakening to: ‘Republicans suddenly discover that Obamacare repeal might not be so awesome, after all‘ or ‘Senate GOP Tips Its Hand: An Obamacare Replacement Could Be A Long Way Off‘.

If like me you are interested in how this unfolds I encourage you to follow the conversation on twitter via #PriceWatch and #TrumpCare hashtags.

More will no doubt be revealed! Some earlier context here and here.

Let’s drain the swamp, after all we now what works!

==##==

Trumpcare Resources c/o Fred Goldstein:

https://www.donaldjtrump.com/positions/healthcare-reform

http://www.cbsnews.com/news/what-will-trump-do-about-obamacare/

http://www.politico.com/story/2016/11/obamacare-defenders-vow-total-war-231164

https://www.govtrack.us/congress/bills/114/hr3762/summary

http://healthaffairs.org/blog/2016/11/09/day-one-and-beyond-what-trumps-election-means-for-the-aca/

http://www.commonwealthfund.org/publications/blog/2016/nov/challenges-for-president-elect-trump-and-congress?omnicid=EALERT1125198&mid=fgoldstein@accountablehealthllc.com

https://www.greatagain.gov/policy/healthcare.html

http://www.dailykos.com/story/2016/10/23/1584745/-Paul-Ryan-has-three-great-ideas-to-improve-Obamacare

http://www.theatlantic.com/health/archive/2016/11/our-bodies-our-trump/507131/

https://www.greatagain.gov/policy/healthcare.html

http://www.commonwealthfund.org/publications/blog/2016/nov/challenges-for-president-elect-trump-and-congress?omnicid=EALERT1125198&mid=fgoldstein@accountablehealthllc.com

http://www.dailykos.com/story/2016/10/23/1584745/-Paul-Ryan-has-three-great-ideas-to-improve-Obamacare

https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donald-trump-is-beginning-to-face-a-rude-awakening-over-obamacare/

http://www.nationalreview.com/article/442120/obamacare-repeal-republicans-should-ensure-health-care-reform-bipartisan

http://blogs.wsj.com/briefly/2016/11/10/5-questions-about-affordable-care-act-coverage-after-donald-trumps-election/

http://www.johnsoncitypress.com/News/2016/11/13/What-would-health-care-look-like-under-Trump.html?ci=stream&lp=1&p=1

http://www.wsj.com/articles/donald-trump-willing-to-keep-parts-of-health-law-1478895339

http://www.healthcaredive.com/news/speculations-swirl-around-trump-hhs-leadership-pick/430301/

https://www.sciencebasedmedicine.org/medical-science-policy-in-the-u-s-under-donald-trump/

http://thehealthcareblog.com/blog/2016/11/13/dear-mr-president-elect-about-that-ryan-plan-thing/

http://www.modernhealthcare.com/article/20161111/NEWS/161119989?utm_source=modernhealthcare&utm_medium=email&utm_content=20161111-NEWS-161119989&utm_campaign=mh-alert

http://www.hhnmag.com/articles/7843-health-reform-and-the-trump-white-house-implications-for-key-stakeholders?utm_campaign=111516&utm_medium=email&utm_source=hhndaily&eid=254508792&bid=1588113#.WCsKPQk6jpM.twitter

http://www.politico.com/tipsheets/politico-pulse/2016/11/obama-dares-gop-on-obamacare-do-it-better-than-me-217419

http://www.vox.com/2016/11/17/13626438/obamacare-replacement-plans-comparison

http://www.wnd.com/2016/11/7-keys-to-effective-health-care-overhaul/

http://www.nationalreview.com/article/442529/obamacare-donald-trump-repeal-replace-tax-cuts

 

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