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OMB nominee among those seeking to kill ACA


President-elect Trump’s choice of very conservative Republican South Carolina Congressman Mick Mulvaney to head the Office of Management and Budget  is further indication that Mr. Trump and Republican leaders will indeed seek to kill the Affordable Care Act — and probably mostly succeed.

As director of the OMB, Rep. Mulvaney will probably want to cut Medicare and Medicaid spending through  privatization via providing  many Medicare members with “premium support” with which they’d pay for private insurance to replace their Medicare and  giving block grants to the states to help pay for Medicaid. Such more limited federal funding will likely mean big cuts in healthcare for the poor.

“I have voted many times to repeal [the ACA] and I will continue to work toward repealing that law and replacing it with solutions that work for everyone,” Mr. Mulvaney writes on his Web site.

“Obamacare has created an environment where most people can afford to buy health insurance but can’t afford to go to the doctor because of very high deductibles. This ‘solution’ has created more problems than it has solved and we need to repeal it and start over.”

He helped found the House Freedom Caucus,  a group of conservatives, that has issued a report outlining recommended policies to be announced during Mr. Trump’s first 100 days. More than 50 affect healthcare.

The recommendations include such granular details as removing HHS restrictions on sunlamps {which cause cancer}, to changing the physician-fee schedule, to killing a rule mandating that some preventive health services be covered by employer-sponsored health insurance.

To read a Becker’s Hospital Review article on this, please hit this link.

To read the Freedom Caucus report, please hit this link.


Move to value-based care seen continuing


The move to value-based care will continue under the Trump administration, argue Emme L. Deland, New York-Presbyterian Hospital’s  senior vice president and chief strategy officer, and Jonathan Gordon, director of NYP Ventures,  a New York-Presbyterian telemedicine unit, in a post for NEJM Catalyst.

They write:

“At the moment, it seems likely that health care financing will get more attention than health care delivery under the new Administration. Medicaid expansion may be rolled back in some states, and block grants are likely to constrain state Medicaid plans — though a fixed Medicaid budget may drive a more rapid shift toward value-based care in many states. The aspects of the ACA that have attracted the most public attention — the individual and employer mandate, and insurance exchanges and subsidies — are most likely to see significant changes.”

“{W}hile there is a significant chance that the specific mechanics of reform may change, the interest in and demand for value-based care will persist on both sides of the aisle. This can be seen in the 392-37 and 92-8 House and Senate votes that passed MACRA, which established a permanent ‘doc fix’ to Medicare reimbursement rates in exchange for a choice between a complex series of quality and efficiency measures, or participation in risk-bearing value-based payment models.”

“Looking ahead, it is possible that there may be a push for a less-regulated approach toward new models, with state Medicaid plans, private payers, and employers taking more of a lead as a result of a more hands-off CMS and a move toward federal Medicaid block grants. The result could be net positive for innovators in health care, as an even more diverse range of delivery reform approaches is tried — though incumbent providers and payers may be challenged to adapt to yet another changing landscape. Many states and their providers, however, could be financially adversely affected by block grants.”

To read their whole article, please hit this link.

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