This Week – January 28, 2017

This Week in Washington, D.C.

From ACG Governor for Massachusetts, Francis P. MacMillan Jr., MD, FACG

At the State and Local Level: Good news from Massachusetts

The Massachusetts Department of Public Health (DPH) recently eliminated a 20-year moratorium on freestanding ambulatory surgery centers (ASCs), and will allow all currently licensed ASCs to apply for a Determination of Need (DON) certificate without affiliation or in a joint venture with an acute care hospital.  The previously proposed rule would have prohibited freestanding ASCs from applying for a DON for any purpose, unless the ASC is affiliated with, or in a joint venture with, an acute care hospital.  Last year, ACG urged members from Massachusetts to get involved and oppose this draft regulation.  Thank you ACG members in Massachusetts and Massachusetts state organizations!

We need your help again: MOC legislation filed in Massachusetts

Massachusetts Rep. Diane DiZoglio recently introduced a bill prohibiting the Board of Registration in Medicine, insurers, and facilities from requiring physicians to maintain national board certifications as a condition for state licensure, credentialing, or contracting purposes.

Please contact Rep. DiZoglio and express your thanks for introducing HD.2713 (An Act relative to maintenance of certification).

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 76 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.  Contact your ACG Governor today.

From ACG National Affairs Committee Chair, Whitfield L. Knapple, MD, FACG

ACA Repeal Watch: Republicans huddle to strategize but miss own deadline

Republicans in Congress held a GOP policy retreat in Philadelphia this week, discussing how they will repeal and replace the Patient Protection and Affordable Care Act (ACA).  President Donald Trump also attended the retreat and was expected to discuss a repeal and replacement strategy, although the Administration continues to say that they will release more information should Rep. Tom Price, MD (R-GA) be confirmed by the U.S. Senate as the next Secretary of HHS.  The U.S. House Committee on Ways and Means and Committee on Energy and Commerce both stated this week that they are not likely to address repeal legislation for at least another month, which is well behind the initial deadline of January 27th as laid out in the fiscal 2017 budget resolution.  The timeline now seems to be around the end of March.

Republicans and Democrats introduce health reform bills

As Republicans mapped out strategy and logistics in Philadelphia, there were some bills introduced this week that both repeal and expand the ACA.  Senators Bill Cassidy, MD (R-LA) and Susan Collins (R-ME) introduced “The Patient Freedom Act (PFA) of 2017.”  Representative Jan Schakowsky (D-IL), and Senators Sheldon Whitehouse (D-RI), Sherrod Brown (D-OH), and Al Franken (D-MN) introduced the Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act.  Senator Rand Paul, MD (R-KY) introduced the “Obamacare Replacement Act.”

On Monday, January 23rd, Senators Bill Cassidy, MD (R-LA) and Susan Collins (R-ME) introduced “The Patient Freedom Act (PFA) of 2017,” a replacement proposal which would essentially give power back to the states in regards to selecting a health insurance marketplace plan.  The PFA of 2017 proposes 3 available options, including the state’s ability to continue its existing healthcare laws currently enacted under the ACA.  The remaining provisions of the bill include allowing states to select a new alternative healthcare plan, either by their own design, or with federal assistance.  The bill states that it would allow patients to have increased access to healthcare, while eliminating the individual and employer mandates currently imposed by the ACA.  The PFA of 2017 is an effort to bring in bipartisan support, as it allows the state to choose the option to keep the current laws in place without total replacement.  More detailed information about the act can be viewed here.

On Tuesday, January 24th, Congresswoman Jan Schakowsky (D-IL), and Senators Sheldon Whitehouse (D-RI), Sherrod Brown (D-OH), and Al Franken (D-MN) introduced the Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act.  The CHOICE Act creates a “public option” subject to all the same requirements that apply to other plans on ACA exchanges.  The bill provides for the same premium tax credits and cost-sharing reductions available to individual marketplace consumers.

On Wednesday, January 25th, U.S. Senator Rand Paul, MD (R-KY) introduced the “Obamacare Replacement Act.”  The bill eliminates the ACA’s essential health benefits requirements, provides a two-year open-enrollment period under which individuals with pre-existing conditions can obtain coverage, authorizes a tax credit (up to $5,000 per taxpayer) for individuals and families that contribute to health savings accounts (HSAs), removes the annual cap on HSA contributions and expands allowable expenditures, allows individuals to deduct the cost of their health insurance from their income and payroll taxes, allows small businesses and individuals in a trade or professional association to purchase health coverage across state lines, and creates an interstate market that allows insurers to offer policies across state lines.

Note for ACG members: Sen. Paul’s bill provides an exemption from federal antitrust law for physicians in negotiations with health insurers regarding contracts for health care services (applies only to health care professionals excluded from the National Labor Relations Act, and does not apply to contracts or care provided under public health insurance programs).  The bill also allows physicians to deduct an amount from their income taxes equal to what they would otherwise charge for charity medical care or uncompensated care due to bad debt (up to 10% of a physician’s gross income for the taxable year).

ACG is actively involved in all health reform packages and will keep you updated on proposed legislation affecting ACG members and your patients.

What else is ACG monitoring: How is Congress going to pay for health reform?

This week, the Congressional Budget Office (CBO) released an updated budget outlook report on major health care entitlement programs.  The Medicare program grew by 5%, or $26 billion in 2016 (after adjustments), largely led by increased prescription drug spending. The CBO estimates Medicare spending will rise 4%, or $23 billion in 2017 due to increased payments from Medicare beneficiaries.  Medicaid spending grew by 5%, or $19 billion in 2016. The rate of Medicaid growth has slowed following rapid growth during the years of state expansion allowed by the ACA. CBO estimates that Medicaid will grow at 5.5%, or $20 billion in 2017. What’s more, health insurance subsidies are growing faster due to increasing insurance premium levels, and insurance subsidy spending will rise by $9 billion in 2017, reaching a total of $51 billion.

Why is this important?  ACA repeal and replacement creates difficulties in planning for a fiscal 2018 budget proposal.  The 2018 budget proposal is viewed by many as another way to repeal sections in ACA and skirt traditional legislative order.

The previous budget assumed the repeal of the health care law without any replacement costs, and assumes changes to the tax code to pay for lost health care law tax revenues. This year, however, health coverage replacement program costs have to be factored into the new budget proposal, among other priorities.  Medicare and Medicaid programs may be targeted.  Some options may include raising cost-sharing, altering coverage and eligibility requirements, increasing taxes, reducing drug spending, or provider payments/reimbursement.  Reducing drug spending is a natural target.  But reducing provider reimbursement has traditionally been a politically safe option, too.  That is why ACG is actively involved in all health reform packages, and why ACG will continue to work with Congress to improve any repeal, replace, and/or expansion bills impacting GI practices and patients.