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Tuesday Jan 17, 2017

Speak Out to Preserve Health Care Coverage

On Friday, Donald Trump will be sworn in as the 45th President of the United States. Pursuant to our country's rich tradition, the transfer of power from the Obama Administration to the Trump Administration will take place in a peaceful manner.  

Upon being sworn-in as president, Trump and his administration will formally start working with the 115th Congress to pursue an ambitious domestic and foreign policy agenda. At the top of the domestic policy agenda is the repeal of the Patient Protection and Affordable Care Act (ACA).  During a press conference on Jan. 11, President-elect Trump provided his most concise perspective on the issue since winning the election.

"It will be repeal and replace," he said. "It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day. Could be the same hour."

Setting aside how complicated repealing the ACA will be, the complexity of that process pales in comparison to replacing the law. Despite objections from a growing number of governors and congressional Republicans who are calling for a more thoughtful approach to repealing the law, Republican leadership and the Trump Administration are moving forward with repeal at an accelerated pace. The first wounds were inflicted last week.

On Jan. 12, the Senate approved a budget resolution for fiscal year 2017 that includes reconciliation(en.wikipedia.org) instructions that will allow the Senate to repeal large parts of the ACA with a simple majority (51 votes). The House approved a similar resolution on Jan. 13, setting in motion a legislative process seeking to have a full repeal bill approved by the end of February.

In a Dec. 28 letter, the AAFP laid out its priorities with respect to how Congress and the new administration should proceed with health care reform. In that letter, the AAFP clearly stated that currently insured individuals should not lose their coverage due to any action or inaction by Congress or the administration. We also continue to stress the importance of impactful insurance reforms in current law that provide numerous protections for individuals, regardless of whether they have employer-sponsored insurance or purchase insurance through the individual market.  

In addition to our letter, we also joined with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Physicians to communicate a set of principles regarding how Congress should approach their work.

I encourage you to lend your voice to this important debate by sharing how important health care coverage and insurance reforms are to your patients. Use the AAFP’s Speak Out to communicate with your members of Congress on this important issue. If you would like to stay closely connected to our ongoing work on this or any other issue, you should follow @AAFP(twitter.com) and @rshawnm(twitter.com) On Twitter.

The next few months will be quite busy in Washington, D.C. Here are the four items that will dominate the first 100 days of the Trump Administration:

  • cabinet nominations;
  • Supreme Court;
  • Affordable Care Act; and
  • Russia.

PQRS, ICD-10 and the Impact of AAFP Advocacy
On Jan. 9, CMS announced(www.cms.gov) that it "will not apply the 2017 or 2018 downward payment adjustments, as applicable, to any individual eligible professional or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the fourth quarter of CY 2016."

This decision was made following an internal review because CMS determined that updates made to ICD-10 in October 2016 negatively impacted the agency's ability to process data.

This action is consistent with recommendations the AAFP provided to CMS in July 2015 regarding the implementation of ICD-10. At that time, the AAFP called for "additional appeals and agency monitoring for reporting systems that determine appropriate payment for medical services based on quality measures and meaningful use of electronic health records."

CMS is encouraging physicians to refer to the ICD-10 Code Updates message on the PQRS Spotlight webpage(www.cms.gov) or the PQRS ICD-10 Section page(www.cms.gov) for additional information.

AAFP News has an excellent summary about how this may impact your practice. We also have extensive resources on PQRS available for our members.

Wonk Hard
The issue of drug pricing has emerged as a concern for patients and payers. Although the headlines are dominated by the costs of new-to-market blockbuster drugs, the real impact is the escalating costs of existing products -- including generics -- for millions of patients who rely upon them for their health maintenance. Few things catch Washington, D.C., and Wall Street by surprise, but President-elect Trump did so on Jan. 12.

"(What) we have to do is create new bidding procedures for the drug industry, because they're getting away with murder. Pharma. Pharma has a lot of lobbies, a lot of lobbyists, a lot of power. And there's very little bidding on drugs. We're the largest buyer of drugs in the world. And yet we don't bid properly. We're going to start bidding. We're going to save billions of dollars over a period of time."

Stock values for pharmaceutical companies took an immediate hit, and patient advocacy organizations cheered. There is still plenty of work that will need to be done, but it looks like the Pharmaceutical Research and Manufacturers of America may need that $300 million they stockpiled(www.washingtonpost.com) for a Clinton Administration after all.

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.