DW blog: The First 100 Days

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AADA meets with Tom Price to discuss regulatory relief

April 17, 2017
American Academy of Dermatology Association (AADA) staff met with Tom Price, MD, secretary of the U.S. Department of Health and Human Services (HHS), to discuss reducing the regulatory burden on physicians. The Secretary of HHS has the authority over the Medicare Physician Fee Schedule (MPFS) and has also been granted authority by President Trump, via Executive Order, to take steps to minimize the fiscal and regulatory burden of the Affordable Care Act (ACA). The AADA ― along with staff from six other specialties ― requested that Sec. Price propose ACA regulatory relief within the proposed 2018 MFPS ― expected to be released by the Centers for Medicare and Medicaid Services (CMS) in July.

Tom Price MeetingSpecifically, the coalition expressed concerns that the methodology used to calculate the Value Based Modifier (VBM) is flawed, and, therefore, requested that the fee schedule establish a Value Based Modifier (VBM) of zero for 2018. CMS has estimated that more than 60 percent of practices (mostly small and solo) and 36 percent of physicians will incur penalties of either 2 or 4 percent in 2017. 

The coalition also requested that the agency adopt broader hardship exemptions for the Meaningful Use program. Additionally, the group called on HHS to adjust the requirements under the Physician Quality Reporting System (PQRS), specifically by reducing the number of measures that physicians must report.

Dr. Price and his staff were very receptive to the coalition’s requests and stated that they would share the information with CMS. In the past, Dr. Price has also expressed concerns over the administrative load placed on physicians, and stated that he is committed to decreasing over-burdensome regulations.


Trump Administration issues new rules for Obamacare enrollment, network adequacy

April 14, 2017
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule regarding network adequacy in the Affordable Care Act (ACA) health care exchanges. The rules states that CMS would defer to the states’ reviews of the adequacy of health plan networks.

The American Academy of Dermatology Association (AADA) ― along with several other physician and patient organizations ― opposed this proposal, arguing that this policy could create inconsistencies among states with varying levels of adequacy and different methods for assessing adequacy. However, the Administration stated that it anticipates that states will adopt standards per the National Association of Insurance Commissioners (NAIC) network adequacy legislation. The AADA will continue to monitor state network adequacy efforts to ensure patients and providers are protected.

Additionally, the rule shortens the 2018 enrollment period for patients looking to purchase health care through the ACA exchanges to Nov. 1 to Dec. 15. Previously, patients had three months to enroll ― from Nov. 1 to Jan. 31. The rule also allows insurers to pay a lower percentage of beneficiaries’ medical costs in ‘silver’ plans ― insurers can opt to cover 66 percent of medical costs, as opposed to the current 70 percent. The rule also grants insurers the authority to deny coverage to beneficiaries who have not paid their premiums. The rule does not address the individual mandate and it also increased subsidies for the ACA exchanges.


White House names HHS deputy secretary

April 11, 2017
The Trump Administration has nominated Stephen Parente to serve as the assistant secretary of planning and evaluation at the U.S. Department of Health and Human Services (HHS). He will be the principal advisor to HHS Secretary Tom Price, MD. Parente is a health care economist and currently works as a professor at the University of Minnesota.


AHCA moves forward

March 16, 2017
The House Budget Committee has voted 19 to 17 to move the American Health Care Act (AHCA) ― legislation that would repeal and replace the Affordable Care Act ― forward to the House of Representatives. All 14 of the Democrats on the Committee voted against moving the bill forward and were joined by three Republican members: Reps. Mark Sanford (R-S.C.), Dave Brat (R-Va.), and Gary Palmer (R-Ala). The AHCA will now be considered and finalized in the House Rules Committee and will then go to the full House of Representatives.


President Trump picks HHS deputy secretary

March 15, 2017
President Trump has announced his intent to nominate Eric D. Hargan, JD, to serve as deputy secretary of the U.S. Department of Health and Human Services (HHS). Hargan is a shareholder of Greenberg Traurig, LLP, in its Health and FDA Business practice. He previously served as deputy general counsel, principal associate deputy secretary, and acting deputy secretary of HHS under the George W. Bush Administration. Hargan’s nomination will require a Senate confirmation.


AHCA clears House committee

March 10, 2017
The House Energy and Commerce Committee has joined the House Ways and Means Committee in advancing the American Health Care Act (AHCA) ― which would repeal and replace the Affordable Care Act. The Committee voted 31 to 23 to push the bill forward.

The bill will now go to the Budget Committee and will then go to the House floor.


House Committee votes in favor of indoor tanning tax repeal

March 9, 2017
Committee markups on the American Health Care Act (AHCA) ― legislation that would repeal and replace the Affordable Care Act (ACA) ― have begun. The House Ways and Means Committee has already approved its reconciliation recommendations to repeal the ACA. Specifically, the Committee voted 24-15 along party lines to repeal the indoor tanning tax on services performed after Dec. 31, 2017. The Joint Committee on Taxation estimates that the repeal of the indoor tanning tax will result in a $600 million revenue loss over the 2017 to 2026 period. The Energy and Commerce Committee markup is ongoing.

The American Academy of Dermatology Association recently sent a letter to congressional leaders opposing the provision in the AHCA that calls for the repeal of the indoor tanning tax. Read more about the AADA's letter in the March 8 post on DW's First 100 Days blog. 


AADA opposes indoor tanning tax repeal

March 8, 2017
The American Academy of Dermatology Association (AADA) has sent a letter to congressional leaders opposing the repeal of the indoor tanning tax. Among several provisions, the proposed replacement for the Affordable Care Act ― the American Health Care Act (AHCA) ― would repeal the indoor tanning tax.

In the letter, AADA President Henry Lim, MD, states, “With an epidemic of skin cancer which has grown to more than 4 million in number annually, dermatologists have made it a priority to advance public policies that promote prevention and education about skin cancer and the dangers of indoor tanning. By helping to raise awareness of the dangers of indoor tanning, the tax also can serve as a deterrent to help mitigate the risks associated with indoor tanning which are often not shared with customers of indoor tanning facilities.” According the Congressional Budget Office, repealing the indoor tanning tax will add $800 million to the federal deficit.

Other health care groups are lining up to oppose the AHCA. Citing concerns over the reduction in health care coverage, the American Medical Association sent a letter to congressional leaders opposing the legislation. Additionally, the American Hospital Association has stated that the process should not advance until the Congressional Budget Office has estimated the cost of the legislation.

Read more about the AADA’s position on this and other issues in Dermatology World.


House releases ACA replacement plan

March 7, 2017
The U.S. House Energy and Commerce Committee and the Ways and Means Committee have released draft legislation to repeal and replace the Affordable Care Act (ACA).

Specifically, the Ways and Means Committee proposes to repeal the individual and employer mandates as well as the indoor tanning tax, and would allow individuals to use health savings accounts to purchase health care. Additionally, the Ways and Means legislation would provide an age- and income-adjusted monthly tax credit to individuals and families who don’t receive insurance through their employer or the government.

The House Energy and Commerce Committee proposes to phase out the provision in the ACA that calls for Medicaid expansion and would fund state Medicaid programs through a per capita allotment. Several GOP senators have indicated concern with this provision, raising questions about whether the overall legislation has the votes to pass.

Finally, under this new proposal, individuals under the age of 26 may remain on their parents’ insurance and the provision requiring insurers to cover people regardless of pre-existing medical conditions will remain.

The Committees will hold markups on the legislation on Wednesday, March 8.


President Trump offers vision for health care

Feb. 28, 2017
In his address to a joint session in Congress, President Trump offered a glimpse of what a replacement plan for the Affordable Care Act should look like. President Trump reiterated his belief that the individual mandate should be repealed and emphasized the need for a “stable transition” for patients currently on the ACA exchanges. Additionally, he reiterated that a new health care system should help Americans purchase health care coverage through the use of tax credits and expanded health savings accounts. He also called for more flexibility for patients by allowing them to purchase coverage across state lines.


Conservatives rally behind new ACA replacement plan

Feb. 16, 2017
The House Freedom Caucus ― a group of 40 House Republicans ― is backing a new replacement plan for the Affordable Care Act (ACA). The proposal, introduced by Sen. Rand Paul (R-Ky.) would offer a tax credit for individuals of up to $5,000 for health savings accounts to pay for medical care. Additionally, the proposal would remove the standards that insurance companies are required to offer in health plans and would allow insurers to sell plans across state lines. The proposal would also remove some of the protections for patients with pre-existing conditions. A House companion bill to Sen. Paul’s plan will be introduced by Rep. Mark Sanford (R-S.C.).

In related news, House leadership issued an ACA Policy Brief and Resources document that highlights concerns with the ACA and outlines general principles for ACA replacement options. Specifically, the brief states that a replacement could shift Medicaid coverage decisions to the states and would allow states to utilize State Innovation Grants to repair their health insurance markets. The plan also calls for the expansion of health savings accounts, and would provide monthly tax credits for individuals to purchase health insurance that can be kept regardless of the individual's employer, age, and geographic location. 


OMB director confirmed

Feb. 16, 2017
The Senate has voted 51 to 49 to confirm Rep. Mick Mulvaney (R-S.C.) for director of the Office of Management and Budget. In addition to helping prepare and administer the federal budget, OMB measures the performance of federal agencies, supervises and coordinates procurement, financial management, and information policies, and plays a role in the approval of major regulations that could significantly impact the economy. As director, Mulvaney will likely be involved with repeal and replacement efforts on the Affordable Care Act.

The Senate Finance Committee will hold a hearing on Seema Verma today ― President Trump’s pick for CMS administrator. AADA staff will be attending the hearing.


CMS proposes new rules for Obamacare enrollment, network adequacy

Feb. 15, 2017
The Centers for Medicare and Medicaid Services (CMS) has issued a proposal that would amend standards related to network adequacy stating that CMS would defer to the states’ reviews of the adequacy of health plan networks.

Additionally, CMS is proposing to shorten the enrollment period for patients looking to purchase health care through the Affordable Care Act health insurance exchanges. By shortening the enrollment period ― from Nov. 1 to Jan. 31 to Nov. 1 to Dec. 15 ― CMS states that it hopes to stabilize the insurance market by allowing payers more time to process enrollments. Additionally, the rule states that shortening enrollment can shrink the risk pool “because it will reduce opportunities for adverse selection by those who learn they will need services in late December or January.” 

The public comment period on the rule is open until March 7. The American Academy of Dermatology Association will be commenting on the proposed rule.


Senate confirms Tom Price for HHS Secretary

Feb. 10, 2017
The U.S. Senate has voted (52-47) to confirm Dr. Tom Price as Secretary of the U.S. Department of Health and Human Services (HHS) under President Donald Trump. Dr. Price, an orthopedic surgeon, previously served as congressman for Georgia’s 6th district and as House Budget Committee chair and would be the first physician to serve as secretary of HHS in nearly 25 years. Dr. Price has worked on issues affecting dermatology, such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties. Dr. Price has also demonstrated a commitment to decreasing over-burdensome regulations associated with EHR, MACRA, and quality reporting.

In other confirmation news, the Senate Finance Committee will hold a confirmation hearing for Seema Verma, President Trump's pick for CMS administrator, next week.


Senate Committee approves Dr. Price

Feb. 1, 2017
The Senate Finance Committee has approved the nomination of Tom Price, MD, to serve as secretary of HHS. Dr. Price's nomination will now go to the full Senate for a vote.

A vote on Dr. Price's approval was delayed yesterday in the Senate Finance Committee after committee Democrats boycotted the vote. The Committee rules require that at least one Democratic member must be present for the Committee to proceed. However, today Committee Republicans agreed by unanimous consent to temporarily change the committee’s rules, thereby allowing the committee to vote in favor of approving Dr. Price.


New legislation would stop IPAB

Jan. 31, 2017
Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee, has announced his plans to introduce a resolution and legislation that would prevent the Independent Payment Advisory Board (IPAB) process from moving forward. The IPAB — instituted as part of the ACA — consists of a 15-member panel of appointed officials that are tasked with containing Medicare costs if they exceed certain levels. Currently, no IPAB members have been appointed and spending has not yet exceeded the target at which recommendations would be required. However, the IPAB would remove congressional oversight of the Medicare program, sparking concerns across both sides of the aisle.


Senate Finance Committee schedules vote on Dr. Price nomination

Jan. 30, 2017
The Senate Finance Committee has scheduled an Open Executive Session for Tuesday, Jan. 31 at 10:00 a.m. eastern to discuss and potentially vote on the nomination of Dr. Tom Price as secretary of the U.S. Department of Health and Human Services.

Dr. Price, an orthopedic surgeon, previously served as congressman for Georgia’s 6th district and as House Budget Committee chair and would be the first physician to serve as secretary of HHS in nearly 25 years.


Sen. Rand Paul unveils ACA replacement plan

Jan. 27, 2017
Another blueprint for replacing the Affordable Care Act has entered the mix. Sen. Rand Paul (R-Ky.) has introduced his version of a replacement called the Obamacare Replacement Act. Sen. Paul’s plan would remove the individual mandate and the minimum standards of care. It would also allow people with pre-existing conditions to sign up for care for two years ― although it is unclear what would happen to those individuals after two years. Sen. Paul’s plan would also provide a $5,000 tax credit that could be placed in a health savings account, and would allow insurers to sell health plans across state lines. His plan does not include a provision that would allow people under the age of 26 to remain on their parents’ health plans.


President Trump reiterates call for swift action on ACA repeal

Jan. 26, 2017
At the Republican party’s annual retreat in Philadelphia, President Donald Trump called on Republicans to take swift action on repealing the Affordable Care Act, stating that Congress has “no choice. If we waited two years, it’s going to explode like you’ve never seen an explosion.” President Trump did not offer details on his thoughts about what an ACA replacement plan should look like. However, in recent comments he has promised "insurance for everybody."


Speaker Ryan sets deadline for Obamacare repeal, replacement

Jan. 26, 2017
Speaking at the Republican party’s annual retreat in Philadelphia, House Speaker Paul Ryan stated that Republicans will repeal and replace pieces of the Affordable Care Act by the spring. Rep. Ryan said that his colleagues could expect several House committees to deliver a reconciliation package in the next several weeks and that the final reconciliation package will be on the House floor by late February or early March.

President Donald Trump is heading to Philadelphia to address the GOP and it is expected that he will offer details on his thoughts about ACA replacement options.


GOP heads to Philly to talk ACA repeal

Jan. 25, 2017
Congressional Republicans are heading to Philadelphia for their annual retreat to discuss a broad policy agenda. High on the list of topics to discuss will be how Republicans can repeal and replace the Affordable Care Act without hurting Americans who currently have coverage under the law. Shortly after the retreat, lawmakers will hold hearings and draft legislation that would repeal and replace the ACA. The House Budget Committee will hold a hearing on Jan. 31, titled "The Failures of Obamacare: Harmful Effects and Broken Promises.” The House Ways and Means Committee will also begin examining the 'effectiveness of the individual mandate.'

Per the recently passed fiscal 2017 budget resolution, the Senate Finance and Health, Education, Labor and Pensions Committees and the House Energy and Commerce and Ways and Means Committees have been tasked with drafting budget reconciliation bills that would include details on repealing the ACA by Jan. 27. However, it is unlikely that the committees will meet the deadline.


Dr. Price discusses ACA, regulatory burdens, transparency, and drug prices in nomination hearing

Jan. 24, 2017
Rep. Tom Price, MD (R-Ga.) ― President Trump’s pick for secretary of the Department of Health and Human Services (HHS) ― sat before the Senate Finance Committee, which will determine if his nomination proceeds to a confirmation vote, and answered questions about several health care issues.

Affordable Care Act
Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee, referenced President Trump’s executive order that directs the secretary of HHS to work toward the swift repeal of the ACA. Sen. Wyden asked Dr. Price if he could assure that no one citizen will be worse off if the ACA is repealed? Dr. Price committed to working with Congress to ensure access to high-quality care. Piggybacking off of Sen. Wyden’s question, Sen. Sherrod Brown (D-Ohio) asked if Dr. Price would enforce the ACA’s ban on discriminating against patients with pre-existing conditions or patients with illnesses that are expensive to treat. Dr. Price responded, “Nobody ought to lose their insurance because they get a bad diagnosis.”

Sen. Pat Roberts (R-Kan.) asked what tools Dr. Price will utilize to provide stability and improve the individual insurance markets to make them more appealing so that insurance carriers will want to come back? Dr. Price stated, “This law isn’t working. It’s not working for patients. One of the goals I have is to lower the temperature in this debate.” He indicated that government should assure carriers that the replacement plan will be more attractive to insurers.

When asked by Sen. Richard Burr (R-N.C.) what his overall goals are for an ACA replacement plan, Dr. Price reiterated his desire to provide accessible and affordable coverage for high quality care while offering patients choices.

CMMI
Sen. Orrin Hatch (R-Utah), chair of the Senate Finance Committee, asked Dr. Price about his thoughts on the Center for Medicare and Medicaid Innovation (CMMI) ― the agency under CMS that develops and tests value-based payment models. “Innovation is so incredibly important to health care and the vibrant quality of health care that we need to be able to provide to our citizens,” Dr. Price said. “One of the roles that we as policymakers have is to incentivize innovation. The Center for Medicare and Medicaid Innovation is a vehicle that might do just that. I think, however, that CMMI has gotten off track a bit. I think that what it has done is defined areas where it has mandatorily dictated to physicians and other providers in this country in certain areas how they must practice. I’m a strong supporter of innovation but I hope that we can move CMMI in a direction that actually makes sense for patients.”

Regulatory burdens
Sen. Roberts referenced various regulations, such as meaningful use, that have caused undue burdens on providers and asked Dr. Price how he will work to alleviate the burden. In response, Dr. Price agreed stating that, “The regulatory scheme that we’ve put in place is choking the individuals that are actually trying to provide care. So much so that you have physicians and other providers who are leaving the practice. The meaningful use project makes it that much more difficult. We’ve turned physicians into data entry clerks.” Dr. Price went on to say that recognizing the problem is the first step and then government must take a second look at the consequences of what it has done.

Transparency: Quality and cost
Sen. Pat Toomey (R-Pa.) asked Dr. Price about his opinions on transparency in health care, to which Dr. Price stated firmly that quality and cost information regarding care should be available to patients. “Outcomes are important and we need to be measuring what makes sense from a quality standpoint and allow patients and others to see what those outcomes are,” Dr. Price said. “But it’s transparency in pricing as well. If you’re an individual and want to know what something costs, it’s virtually impossible to find out what that is. If we want to make the system patient-friendly, not insurance-friendly or government-friendly, then we would make that a priority.”

Drug pricing
With regard to access to medications, Sen. Wyden asked Dr. Price if he would be willing to follow President Trump’s recommendation and allow federal health care plans the authority to negotiate drug prices. In response, Dr. Price said, “Right now the PBMs [pharmacy benefits managers] are doing that negotiation. It’s important to have the conversation and look at whether or not there’s a better way to do that. If there is, then I’m certainly open to it.”

In addition to a litany of questions on various health care related issues, several members of the committee reiterated concerns about the ethics of Dr. Price’s investments in various health-related companies while supporting bills that could have benefited these companies. The Senate Finance Committee will vote on Dr. Price’s nomination within the next several weeks.


GOP senators introduce new ACA repeal, replace legislation

Jan. 24, 2017
Sens. Susan Collins (R-Maine), Bill Cassidy, MD (R-La.), Shelley Moore Capito (R-W.V.), and Johnny Isakson (R-Ga.) have introduced the Patient Freedom Act (PFA) of 2017, which would repeal and replace the Affordable Care Act (ACA). The bill would repeal the individual and employer mandates but would retain several ACA consumer protections, such as the prohibition of discriminating against patients with pre-existing conditions. It would also allow young adults to remain on their parent’s insurance plan until age 26. The PFA also gives states the authority to choose one of three options: re-implement the ACA; choose a new state alternative; or design an alternative solution without federal assistance.


President Trump issues executive order to repeal ACA

Jan. 21, 2017
Merely hours after swearing in as the 45th President, Donald Trump signed an executive order calling for the swift repeal of the Affordable Care Act (ACA). President Trump’s executive order stated that in the interim, the law must be upheld. However, he called on his Administration to take steps to minimize the fiscal and regulatory burden of the law on citizens, providers, states, insurers, and other healthcare stakeholders by delaying or waiving any new regulation required under the ACA.

While the executive order does not have any immediate impact on the ACA, it provides direction for Congress and agencies such as the Treasury Department and HHS to follow through on Trump's request for repeal.


Dr. Price faces Senate HELP committee in nomination hearing

Jan. 18, 2017
The Senate Health, Education, Labor and Pensions (HELP) Committee held a nomination hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for secretary of the Department of Health and Human Services. The American Academy of Dermatology Association attended the hearing. Among several health care related issues that were addressed during the hearing, most notably Dr. Price was asked about his thoughts on a replacement for the Affordable Care Act (ACA), access to drugs, and regulatory burdens on physicians. Additionally, Dr. Price addressed concerns about his financial ties to a medical device company.

ACA replacement
When asked by Committee Chair Sen. Lamar Alexander (R-Tenn.) about Dr. Price’s goal for an ACA replacement plan, Dr. Price stated that health care needs to be affordable, accessible, high quality, and responsive to patients, offer incentives for innovation, and ensure choices are made by and preserved for patients. When asked about the timing of repeal and replace, he stated, “I think that one of the important things that we need to convey to the American people is that nobody is interested in pulling the rug out from anybody.” Dr. Price also expressed an interest in implementing high-risk pools and expanding the use of health savings accounts in a replacement plan to cover general health services.

Medicare drug price negotiations
Sen. Bernie Sanders (I-Vt.) asked Dr. Price if he would join him and Democrats in efforts to allow Medicare to negotiate drug prices and allows drugs to be imported from Canada. Without confirming his position on government price negotiations or importation, Dr. Price stated that the cost of drugs is a high priority for all Americans and he committed to working with Congress in addressing the drug pricing issue.

Regulatory burdens
Sen. Bill Cassidy (R-La.) asked Dr. Price for his thoughts on what the government can do to address the regulatory burden that physicians are experiencing with electronic health record (EHR) requirements, such as Meaningful Use. Dr. Price said that EHRs are important from an innovative standpoint because they allow patients access to their medical history. However, he said that the federal government’s role is to ensure interoperability between EHR systems. Additionally, he indicated that the government should work more closely with providers in determining the metrics that should be measured through these systems to improve quality. “If we truly worked with the providers and asked them what we should measure, I suspect that there are some very specific things we could use.”

Government authority in health care
Sen. Pat Roberts (R-Kan.) expressed his concerns about the increased authority of the Independent Payment Advisory Board (IPAB), the Centers for Medicare and Medicaid Innovation (CMMI), the U.S. Preventative Services Task Force (USPSTF), and the Patient-Centered Outcomes Research Institute (PCORI). Dr. Price stated his concerns about CMMI, indicating that the patient should be at the center of care and that health care treatments should not be dictated by government.

Questions on ethics
Committee Ranking Member Sen. Patty Murray (D-Wash.) and Sen. Elizabeth Warren (D-Mass.) questioned the ethics of Dr. Price’s ties to a medical device company. Recently, information has been released about Dr. Price’s personal investments and potential ties to his legislative actions. According to House records, in 2016 Dr. Price bought between $1,001 to $15,000 worth of shares in Zimmer Biomet ― a knee and hip implant manufacturer. Shortly after the purchase, Dr. Price introduced the HIP Act that would have delayed a CMS regulation that would hurt Zimmer Biomet financially. Zimmer Biomet's PAC also donated to Dr. Price's reelection campaign.

When questioned at the hearing, Dr. Price indicated that the trade in Zimmer Biomet shares in his broker-direct account was handled by a broker and also denied knowledge of nonpublic information when trading certain stocks. Sen. Orrin Hatch (R-Utah) asked, “Can you confirm that you have always followed the law relating to trading in stocks while serving as a member of Congress?” Dr. Price responded, “Everything that we have done has been above board, transparent, ethical, and legal. The Office of Government Ethics has looked at our holdings and given advice on what needs to be done in terms of divesting from certain stock holdings to make certain that there are no conflicts of interest. We have read those, agreed to those, and signed those. That document is online for everybody to see.” View Dr. Price’s public financial disclosure report and his ethics agreement.

The HELP Committee hearing is considered a courtesy hearing. A formal hearing before the Senate Finance Committee ― the committee that will vote on Dr. Price’s nomination ― is scheduled for Jan. 24.


Nomination hearing scheduled for OMB pick

Jan. 18, 2017
The Senate Budget Committee has announced that it will hold a hearing on the nomination of Rep. Mick Mulvaney (R-S.C.) ― President-elect Donald Trump’s pick for director of the Office of Management and Budget ― on Jan. 24. A formal hearing for Dr. Tom Price's nomination as HHS secretary before the Senate Finance Committee ― the committee that will vote on Dr. Price’s nomination ― is also scheduled for Jan. 24.

In addition to helping prepare and administer the federal budget, OMB measures the performance of federal agencies, supervises and coordinates procurement, financial management, and information policies, and plays a role in the approval of major regulations that could significantly impact the economy. If confirmed, Mulvaney would be involved with expected efforts to roll back the Affordable Care Act (ACA) and other reforms implemented by the Obama Administration.


U.S. House votes to begin ACA repeal process

Jan. 13, 2017
The U.S. House of Representatives has voted 227-198 for a budget resolution that tasks several committees with drafting budget reconciliation bills that would include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. The budget resolution was recently approved by the Senate, so the appointed committees can now begin drafting reconciliation legislation.


Speaker Ryan: Expect action on ACA within first 100 days

Jan. 12, 2017
House Speaker Paul Ryan (R-Wis.) says that he anticipates action on repealing and replacing the ACA within the first 100 days of President-elect Donald Trump's term. Speaker Ryan discussed the fate of the ACA at a CNN Town Hall meeting at George Washington University. In addition to discussing a timeline for repeal, he stated that a replacement for the health care law would likely provide coverage for patients with pre-existing conditions. Additionally, he indicated that the House Republican replacement plan would allow individuals to receive refundable tax credits to purchase a plan that's right for them, and that Health Savings Accounts would be a “critical piece” of an ACA replacement. Read more highlights from the Town Hall meeting.


President-elect Trump addresses ACA, drug prices in first press conference

Jan. 11, 2017

In his first press conference as President-elect, Donald Trump has restated his position that the Affordable Care Act (ACA) should be repealed and replaced as soon as possible. He stated, “We're going to be submitting, as soon as our secretary [Dr. Tom Price] is approved, almost simultaneously ― shortly thereafter ― a plan. It will be repeal and replace. It will be, essentially simultaneously.”

Additionally, President-elect Trump reiterated his position that Medicare should be allowed to negotiate drug prices. “We’re the largest buyer of drugs in the world, and yet we don't bid properly…were going to start bidding and were going to save billions of dollars over a period of time,” the President-elect said.

Click here to read a transcript of the press conference.


Senate takes another step toward ACA repeal

Jan. 11, 2017
The Senate has voted 51-48 for a budget resolution that tasks several committees with drafting budget reconciliation bills that would include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. The budget resolution must now be approved by the House of Representatives before the appointed committees can begin drafting reconciliation legislation.


ACA repeal: Some Republicans ask for more time

Jan. 10, 2017
While Congress appears to be moving forward on ACA repeal, several members of the GOP are raising concerns about repealing the law without a comprehensive replacement strategy. The House Freedom Caucus is calling for more information on what repeal and replacement would look like before voting on the 2017 budget that would include includes Obamacare repeal instructions. “We need to slow down the process so we can understand a little bit more the specific and timetable of replacement votes and reconciliation instructions, etc.," said Freedom Caucus Chairman Mark Meadows (N.C.).

Additionally, Republican Sens. Bob Corker (Tenn.), Rob Portman (Ohio), Susan Collins (Maine), Bill Cassidy (La.) and Lisa Murkowski (Alaska) have filed an amendment that would extend the deadline for congressional committees to pull together a repeal and replacement plan ― via the budget reconciliation process ― from Jan. 27 to March 3. "By providing more time to come up with legislative solutions, we have a better opportunity to produce a thoughtful, workable replacement that ensures Americans have access to affordable, diverse insurance plans that meet their needs," Sen. Collins said in a statement.

The Senate is expected to vote on budget resolution amendments this week. It is unclear if the Senators’ filed amendment or the Freedom Caucus’ concerns will have an impact on the timing of the repeal and replace process.


Indoor tanning tax: Should it stay or should it go?

Jan. 9, 2017
As members of Congress inch closer to repealing the Affordable Care Act (ACA), questions remain on whether or not to repeal the taxes implemented as part of the law. There are roughly 21 new or increased taxes folded into the ACA ― including the 10 percent excise tax on indoor tanning. The debate hinges on whether Congress should scrap the entire bill including all the taxes ― leaving little revenue in place to cover the subsidies for those insured under the ACA until a replacement plan is put in place ― versus keeping the taxes in place for a larger tax reform effort down the road.


Congress appoints new E&C Health Subcommittee leader

Jan. 6, 2017
House Energy and Commerce Committee Chair Rep. Greg Walden (R-Ore.) has announced that Rep. Michael Burgess, MD (R-Texas) will serve as the leader of the House Energy and Commerce Health Subcommittee. The Health Subcommittee will play a large role in repealing and replacing the Affordable Care Act (ACA). The subcommittee also manages issues related to the CHIP program and FDA user fees.

Read more about Rep. Burgess’s thoughts on the ACA in the October issue of Dermatology World.


House Republicans introduce Obamacare replacement plan

Jan. 5, 2017
While repeal efforts for the Affordable Care Act (ACA) are well underway, several members of Congress are honing in on possible replacements for the law. The Republican Study Committee (RSC), led by its chairman Rep. Mark Walker (R-N.C.) and Phil Roe, MD (R-Tenn), has introduced a new replacement plan, the American Health Care Reform Act. This proposal would expand the use of health savings accounts, allow insurance companies to sell plans across state lines, and would issue block grants to Medicaid programs. The bill calls for a full repeal of Obamacare starting on Jan. 1, 2018, though it does not set a timeline for replacement.

The plan is similar to House Speaker Paul Ryan’s (R-Wis.) A Better Way plan in that it would provide coverage for people with pre-existing conditions and supply states with funding to establish high-risk pools. However, the RSC’s American Health Care Reform Act would create tax deductions ― $7,500 for an individual and $20,500 for married couples ―  if they purchase a qualified health plan. Speaker Ryan’s A Better Way plan, on the other hand, would allow people to receive tax credits to purchase coverage.

Over the next several months, it is likely that the RSC’s plan will be one of several replacement proposals issued by the GOP.


Senate moves closer to repealing pieces of Obamacare

Jan. 5, 2017

In the first official step toward repealing the health care law, the U.S. Senate voted 51-48 to begin consideration of Senate Budget Committee Chairman Mike Enzi's (R-Wyo.) budget resolution that tasks several committees with drafting budget reconciliation bills that would include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. Under congressional budget rules, Congress could remove certain provisions under the ACA through this budget reconciliations process, requiring only a simple majority for passage, as opposed to a full repeal that would require a super majority.

Next week, votes are expected in the Senate on budget resolution amendments, with Democrats reportedly planning to propose amendments supporting various provisions of the ACA. Once the resolution clears the Senate, the House of Representatives is expected to swiftly consider the measure.


Rep. Black steps in for Dr. Price at House Budget Committee

Jan. 4, 2017
House Speaker Paul D. Ryan (R-Wis.) has announced that Rep. Diane Black (R-Tenn.) will serve as interim chair for the House Budget Committee ― stepping in for Rep. Tom Price, MD (R-Ga.) as he goes through the confirmation process for Secretary of the U.S. Department of Health and Human Services. If Dr. Price is confirmed, the House GOP Steering Committee would name a permanent chair ― a position that, as interim chair, Rep. Black would likely assume. If Dr. Price is not confirmed, he could return as chair.

The House Budget Committee would be heavily involved in the repeal of various pieces of the Affordable Care Act through the budget reconciliation process. “As interim Chairman for the House Budget Committee, I am ready to work with my colleagues on both sides of the aisle to repeal this law that has burdened families and businesses and turn the page to a new healthcare system that lowers costs, spurs free market competition, and ultimately empowers patients — not Washington bureaucrats,” Rep. Black said.


New Congress, new ACA repeal efforts

Jan. 3, 2017
It’s the first day of the 115th Congress, and several members are hitting the ground running on their promise to repeal the Affordable Care Act (ACA). Vice President-elect Mike Pence is scheduled to visit Capitol Hill this week to discuss repeal and replacement options with House Republicans. Meanwhile, President Obama will meet with Democratic members to discuss efforts to avoid repeal of the ACA.

Under congressional budget rules, Congress could remove certain provisions under the ACA through a process called budget reconciliation that requires only a simple majority for passage. Senate Budget Committee Chairman Mike Enzi (R-Wyo.) has introduced a budget resolution that provides reconciliation instructions to the Senate Finance and Health, Education, Labor and Pensions Committee as well as the House Energy and Commerce and Ways and Means Committees. Each committee is tasked with finding at least $1 billion in deficit reduction from fiscal 2017 through fiscal 2026, and to draft a reconciliation bill by Jan. 27. These bills will include details on repealing the ACA ― including specific pieces of the legislation to repeal as well as timelines for replacement. Once crafted, the committees’ reconciliation bills will be combined for consideration in the House and the Senate.

Under House rules, the House of Representatives will be able to pass repeal with a simple majority vote, but Senate rules, which require 60 votes to end debate, could complicate ACA repeal efforts in that chamber where Republicans currently hold 52 of the 100 U.S. Senate seats. Democrats hold 46 seats, with the other two seats being held by independent senators who caucus with Democrats.


Tentative hearing scheduled for Dr. Price nomination

Jan. 3, 2017
The Senate Health, Education, Labor and Pensions Committee has set a tentative date for a hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for Secretary of the U.S. Department of Health and Human Services ― on Jan. 18. However, the hearing date will not be officially announced until one week before it is definitively scheduled to occur. This is would be a courtesy hearing, as it is the Senate Finance Committee that will ultimately vote on the nomination.

The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.

Similarly, Seema Verma, President-elect Trump’s choice for CMS administrator, can anticipate a confirmation hearing in the near future. Although a date for her hearing has not been publicly floated, the Senate Finance Committee indicates that it has received three years of tax returns and completed questionnaires from both Dr. Price and Verma.


ACA replacement: A question of 'when?'

Dec. 20, 2016
While Congress and President-elect Donald Trump have vowed to repeal the Affordable Care Act (ACA) out of the gate in 2017, the timing for replacing Obamacare is still up for discussion. The two primary issues at hand: how long will the 20 million Americans enrolled in an ACA insurance plan need to find a suitable replacement, and how long will insurance companies need to create and price new plans? Members of the House Freedom Caucus are hoping for a six-month transition period, insurance companies are indicating that 18 months may be more manageable, and some sources say Obamacare may remain in place for at least four years after repeal. Regardless of replacement timing, repeal efforts are likely to move fast when the 115th Congress and President-elect Trump are sworn in.


Congress names top Democrat for House W&M Committee

Dec. 6, 2016

Rep. Richard Neal (D-Mass.) has been selected as Ranking Member on the House Ways and Means Committee, which has jurisdiction over tax- and revenue-related issues. Specific to dermatology, the Committee would be responsible for addressing a repeal of the 10 percent indoor tanning tax, and would likely play a role in any efforts to reform Medicare and/or repeal and replace the Affordable Care Act.


As IPAB cuts loom, support for repeal grows


Dec. 2, 2016
Efforts to repeal the Independent Payment Advisory Board (IPAB) are gaining momentum as the threat of Medicare cuts appears increasingly likely. The IPAB was instituted as part of the Affordable Care Act and would task a 15-member panel of appointed officials with containing Medicare costs if costs exceed certain levels. If a board is not appointed, the Secretary of the U.S. Department of Health and Human Services would be responsible for making cuts. These cuts would only be overridden by a supermajority in the Senate (60 votes) ― a provision that members of Congress see as undermining congressional authority. 

Currently, no members have been appointed to the IPAB board and spending has not yet exceeded the target at which recommendations would be required. However, current predictions indicate that spending in 2017 could trigger cuts in 2019.


Congress appoints new E&C chair

Dec. 1, 2016
While President-elect Donald Trump’s transition team is vetting members of the new Administration’s cabinet, on Capitol Hill, Rep. Greg Walden (R-Ore.) has been selected as the chair of the U.S. House Energy and Commerce Committee which has jurisdiction over issues concerning health care, and is the primary committee for addressing the Affordable Care Act, the Medicare Access and Chip Reauthorization Act (MACRA), compounding, drug pricing, and the 21st Century Cures bill that, if passed, would provide medical research funding. Rep. Walden will replace Rep. Fred Upton (R-Mich.), who has served in the role since 2010. Rep. Walden is the outgoing National Republican Congressional Committee chairman. According to his congressional website, he is in favor of repealing and replacing the Affordable Care Act and he also supported the 21st Century Cures Act.


President-elect Trump picks Dr. Price for HHS

Nov. 30, 2016
President-elect Donald Trump has nominated House Budget Committee Chair, Rep. Tom Price, MD (R-Ga.), to serve as Secretary of the U.S. Department of Health and Human Services.

Dr. Price, an orthopedic surgeon, has been a staunch supporter of the full repeal of the Affordable Care Act (ACA) ― he introduced the Empowering Patients First Act in 2015 which would fully repeal and replace the ACA with a system that includes individual health pools and expanded health savings accounts, and would have given physician groups control over performance-based quality measures. As a physician, Dr. Price has indicated that he understands the administrative burdens placed on the physician community and has expressed concerns over the burdens of electronic health records and Meaningful Use ― indeed, he was instrumental in the passage of a blanket hardship exemption from MU requirements in 2015. He also supports allowing physicians to balance bill their Medicare patients, repealing the Independent Payment Advisory Board (IPAB), allowing the use of in-office compounded drugs, preserving the In-Office Ancillary Services Exception to the Stark Law, and ensuring that step therapy protocols do not impede patient access to necessary treatment. 

The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.

President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January. The AMA and other medical organizations have announced their strong support for Dr. Price's nomination.


What about the IPAB?

Nov. 29, 2016
There has been a massive political push to repeal and replace the Affordable Care Act, but how will it affect dermatology? While the American Academy of Dermatology Association (AADA) was concerned with the ACA when it was implemented, it redirected its focus to improving the law so that it does not undermine patients’ access to dermatologic care. Specifically, the AADA continues to call for repeal of the Independent Payment Advisory Board (IPAB) — instituted as part of the ACA — which consists of a 15-member panel of appointed officials that are tasked with containing Medicare costs if costs exceed certain levels. Currently, no members have been appointed and spending has not yet exceeded the target at which recommendations would be required. However, “Current predictions indicate that 2017 Medicare spending will trigger cuts in 2019,” said Michelle Mathy, assistant director of political and congressional affairs at the AADA. 

According to Mathy, one major challenge in repealing the IPAB, however, is that Republicans will want to offset the cost of repeal — which has a price tag of about $13 billion. Coming up with such offsets has been one of the chief difficulties in passing legislation in recent years. Additionally, Trump has not specifically expressed an opinion either way on IPAB. If the full ACA is repealed, the IPAB would be repealed as well.

If the ACA is not repealed, the IPAB would have to be addressed on its own. If Republicans use the reconciliation process ― which gets around the 60-vote filibuster threshold and can only be used for legislation that affects the deficit ― things get complicated. “When the Republican Congress voted to repeal parts of the ACA under the reconciliation process last year, the Senate parliamentarian ruled that the provision to repeal IPAB violated the Byrd Rule which requires reconciliation bills to have a budgetary impact,” said Christine O’Connor, AADA associate director of congressional policy. “As a result of that ruling the provision was removed from the bill.” Essentially, the IPAB would have to be addressed and repealed in a separate bill ― a possibility given that repeal of the IPAB has garnered bipartisan support.

Read more about how the new Congress and Administration are likely to address these issues in the October issue of Dermatology World.