Health Care Reform Update 3/1/2016

Clients and Friends…
I would like to tell you that my recent trip to Washington DC was an unqualified success, but that would not be accurate. Although, I am optimistic that progress was made.

It’s important to realize that the wheels grind slowly in DC. There are competing interests that span the entire spectrum. Our representatives only have 20 minutes to discuss with us our issues and our points of view. My professional association works with congress and the administration throughout the year and are very good at identifying where we can be effective. For example, my association is providing information to Speaker Paul Ryan about a replacement to the Affordable Care Act, but we are also looking to promote bi-partisan changes to the law to make it more tenantable in the interim.

I don’t expect any significant structural changes to the law until a new administration takes the presidency. If Hillary is elected, it will be almost the same as current but the taxes and fees will be increased to pay for the law. If a republican is elected, the changes could be similar to the Burr Coburn Hatch legislative proposal that turned into the Patient’s Choice Act of 2009, or from Ryan Kline and Upton a plan that is being developed in the Ways and Means Committee.

However, affordability is still a challenge that is not being effectively addressed. Providers are entrenched in a “fee for service” payment model where they are paid for procedures they perform. The biggest expenses are from hospitals and other facilities, as well as pharmaceuticals. There are alternative payment models that are being tried and the most promising is “patient centered medical homes” which doesn’t mean what it sounds like, but pays providers on the outcome or quality of the care. I also expect pharmacy benefits being reduced in the next few years as legislation is considered to change laws impacting monopoly pricing of medicine.

I will keep you up to date with the changes I see coming. If you have any questions, or want to discuss how the changes may affect you, please contact me.

Thank you,
…Gene

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