House Committee Reviews MACRA and APMs
On Wednesday, the House Energy and Commerce Health Subcommittee held a hearing to evaluate the transition to value based care for physicians, including the development of Alternative Payment Models (APMs) established under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The first panel included Dr. Jeffrey Bailet and Ms. Elizabeth Mitchell, the respective Chair and Vice-Chair of the Physician-Focused Payment Model Technical Advisory Committee (PTAC). PTAC oversees new Medicare payment models before submitting them to HHS. Dr. Bailet and Ms. Mitchell outlined three barriers to establishing effective alternatives: the need for technical assistance to help physicians transition from fee-for-service to value-based care; greater access to shared data; and the need to test new, small-scale models. The second panel included stakeholders, including some physician organizations, who are already using APMs.

ACEP has been in contact with the committee and offered to share our expertise and experience in developing the successful Clinical Emergency Data Registry (CEDR) , which supports emergency physicians’ efforts to improve quality and practice in all types of emergency department settings.

To view the hearing, click here .

Individual Mandate Repeal Left Out of Tax Reform Proposals – For Now
As congressional legislators prepared their tax reform proposal this week, rumors and speculation swirled about the possible inclusion of a repeal of the Affordable Care Act’s (ACA) individual mandate to purchase health insurance coverage. Several GOP members have been pushing Republican leadership to include the repeal both to help pay for the tax reform package and to deliver a victory on the broader ACA repeal effort, but neither the bill approved by the House Ways & Means Committee on Thursday or the proposal released by the Senate this include the provision. However, the White House is reportedly supportive of the individual mandate repeal being included, and legislators continue to push behind the scenes to amend the tax reform package to include it, so much can change as the process continues.

A new estimate issued by the Congressional Budget Office this week indicates that the repeal would save $338 billion but result in 13 million more uninsured individuals over the next decade. Throughout the health care reform debate this year, ACEP has opposed efforts that result in fewer individuals with insurance coverage, as the burdens of increased patient loads and crowding ultimately fall on emergency departments across the country and patient care suffers as a result. ACEP continues to monitor this effort and work with legislators to advocate for solutions that improve patient access to care.

CMS Administrator Seema Verma Lays Out Medicaid Changes
In remarks delivered to the National Association of Medicaid Directors on Tuesday, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma laid out plans to allow for significant changes to the Medicaid program, most notably by allowing states to impose work requirements for enrollees. In addition to streamlining and reducing the burdens of the waiver process, CMS intends to approve state waivers that include “community engagement” requirements such as volunteer work or job training.

Several states, including Kentucky and Indiana, are expected to seek waivers to establish work requirements. Verma also indicated the Administration is prepared for the inevitable legal challenges that have been threatened by opponents of work requirements.

ACEP policy advocates for health coverage that provides timely, unrestricted access to quality emergency care, and will continue to monitor any changes to the health care safety net provided under the Medicaid program.

Health Care Reform’s Role in the Nov. 7 Statewide Elections
Voter support of the ACA played a role in the Governor’s race in Virginia and a ballot initiative in Maine in this week’s elections. Nearly four in 10 Virginia voters listed health care as their top policy issue, according to CNN—and 77% of those voters broke for Democrat Ralph Northam who handily defeated Republican Ed Gillespie to become Virginia’s next Governor. But the more surprising element of the Virginia election results may be that Democrats flipped about a dozen seats in the Republican-dominated Virginia House of Delegates. Several of those races are still too close to call or may require recounts, but when all the votes are tallied, it appears the makeup of the House will be much closer to 50-50. An evenly matched Democrat-Republican split in the state Senate and the Democratic victories for governor, lieutenant governor, and attorney general—could reshape the politics of Medicaid expansion in Virginia as well. Outgoing Virginia Democratic Gov. Terry McAuliffe has tried multiple times to strike a Medicaid deal with the GOP state legislature but as been consistently rebuffed; expanding the program would extend health coverage to an estimated 400,000 Virginians.

And in Maine, voters in a landslide backed a ballot initiative that would expand Medicaid, an initiative that the Republican Governor LePage had vetoed on five separate occasions. About 60% of Maine voters approved the Medicaid ballot measure, which would extend health insurance coverage to about 70,000 low-income state residents and their families.

Medicaid expansion has consistently been one of the ACA’s most popular measures. LePage, however, is already signaling that he won’t implement it despite the overwhelming popular referendum results until it has been fully funded by the Legislature at the levels the HHS has calculated.

ACEP 911 Network Weekly Update, November 10, 2017