Kent Bottles, M.D., a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics, speculates on what could happen next in the healthcare debate in Washington.

Among his observations:

• “Republicans could drop the pending lawsuit that threatens the legality of cost-sharing reduction payments that the federal government sends to insurers to ensure that lower income Americans can have smaller deductibles.
• “The Republicans could enforce the individual mandate so that more younger Americans buy health insurance.
• “The administration could grant states more flexibility to increase competition and decrease costs. (Alaska has already used such an approach to create a reinsurance pool.)
• “The CMS could continue to experiment with value-based payment models, implement MACRA, and expand the bundled payment programs.’’

“The Trump administration can undermine the ACA without Congress passing any new laws. Existing and possible examples include:

• “The administration did not air already-paid-for television ads encouraging young people to sign up for insurance in 2017.
• “The administration can cut the budgets of agencies that are charged with administering the law.
• “The CMS administrator can give state waivers to avoid some of the ACA’s provisions.
• “Department of Health and Human Services Secretary Tom Price, M.D., has criticized the Center for Medicare & Medicaid Innovation—which supports new models of care and payment—and he has delayed the expansion of bundled payments for hip and knee replacement surgery.
• “Decisions by HHS can reassure or disappoint insurers that have to decide by this spring if they will participate in the ACA exchanges. ‘’

“Hospital and physician leaders should plan for the ACA to continue to be the law of the land, and they should recognize that the Republican administration will continue to oppose it.’’

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