How Republicans can hobble Obamacare?

By Julie Steenhuysen — Republicans may have failed to overthrow Obamacare last week, but there are plenty of ways they can chip away at it. The Trump administration has already begun using its regulatory authority to water down less prominent aspects of the 2010 healthcare law.
Earlier last week, newly confirmed Health and Human Services Secretary Tom Price stalled the rollout of mandatory Medicare payment reform programmes for heart attack treatment, bypass surgery and joint replacements finalised by the Obama administration in December.
The delays offer a glimpse at how President Donald Trump can use his administrative power to undercut aspects of the Affordable Care Act (ACA), including the insurance exchanges and Medicaid expansion that Republicans had sought to overturn.
The Republicans’ failure to repeal Obamacare, at least for now, means it remains federal law.
Price’s power resides in how to interpret that law, and which programmes to emphasise and fund.
Hospitals and physician groups have been counting on support from Medicare — the federal insurance programme for the elderly and disabled — to continue driving payment reform policies built into Obamacare that reward doctors and hospitals for providing high quality care at a lower cost.
The Obama Administration had committed to shifting half of all Medicare payments to these alternative payment models by 2018.
Although he has voiced general support for innovative payment programmes, Price has been a loud critic of mandatory federal programmes that dictate how doctors should deliver healthcare.
Providers such as Dr Richard Gilfillan, chief executive of Trinity Healthcare, a $15.9 billion Catholic health system, say they will press on with these alternative payment plans with or without the government’s blessing.
But they have been actively lobbying Trump officials for support, according to interviews with more than a dozen hospital executives, physicians and policy experts.
Without the backing of Medicare, the biggest payer in the US healthcare system which Price now oversees, the nascent payment reform movement could lose momentum, sidelining a transformation many experts believe is vital to reining in runaway US healthcare spending.
Price “can’t change the legislation, but of course he’s supposed to implement it.
He could impact it,” said John Rother, chief executive of the National Coalition on Health Care, a broad alliance of healthcare stakeholders that has been lobbying
the new administration for support of value-based care.
The move last Friday to pull the Republican bill only reinforces the risk to the existing law, which Trump said on Friday “will soon explode.”
“It seems that the Trump Administration now faces a choice whether to actively undermine the ACA or reshape it administratively,” Larry Levitt, senior vice president at Kaiser Family Foundation, wrote on Twitter.
“The ACA marketplaces weren’t collapsing, but they could be made to collapse through administrative actions,” he added.
The United States spends $3 trillion a year on healthcare – more by far than 10 other wealthy countries – yet has the lowest life expectancy and the highest infant mortality rate, according to a 2013 Commonwealth Fund report. Health costs have soared thanks in part to the traditional
way doctors and hospitals get paid, namely by receiving a fee for each service they provide.
So the more advanced imaging tests a doctor orders or pricey procedures they perform, the more money he or she makes, regardless of whether the patient’s health improves.
“We have a completely broken economy in healthcare,” said Blair Childs, senior vice president at hospital purchasing group Premier Inc. “Literally, all of the incentives in fee-for-service are for higher cost.” — Reuters