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Some certainty about health reform in the midst of uncertainty

Yesterday, the House of Representatives passed a revised version of the American Health Care Act (AHCA). Adjusted from the previous version, it allows states to change requirements associated with essential benefits and the coverage and pricing of pre-existing conditions, as well as some additional funding for high-risk pools. The bill passed 217-213 (one more than the minimum necessary), with 20 Republicans voting against it and one Republican member not voting.


Congress and the industry are still waiting for the Congressional Budget Office’s score of the legislation. It is likely to predict, similar to the last report, a sizable reduction in the number of covered lives and a forecast of increased anticipated federal spend, because of additional investments in the high-risk pools.  


AHCA will undergo big changes in the Senate

This action by the House is the first step, but a great deal of difficult work remains in front of Republicans and President Trump before anything can be finalized. The AHCA now goes to the Senate, where it will undergo substantive adjustment or be replaced entirely.


Senator Alexander (R-TN), Chairman of the Senate Health, Education, Labor and Pensions Committee, indicated they will review the House version but will work on their own legislative language that they will focus on passing. He emphasized that they will be deliberative in their work, so it is likely that the timing will not be immediate.  


It’s important to remember that the Senate seeks to conduct the Repeal / Replace using the budget reconciliation process, which only requires 51 votes (as opposed to the normal 60); conversely, even three Republican Senators voting against it would mean it did not pass.  The budget reconciliation process comes with very stringent parliamentarian rules, too, and several elements of the House bill would not pass that review.


Once the Senate passes its own bill, assuming they are able to draft a version that keeps the necessary number of Senators on board, it will have to go back to the House for a repeat of this recent process, including a new vote.


Value-based care isn’t going anywhere

While Congress attempts to work through this process, the Affordable Care Act (ACA) is still the law of the land and will remain so for at least some time. Even in the midst of this activity, the move to value-based payments continues. The AHCA doesn’t change MACRA or other Medicare-based programs in any way.


The requirements to collect, share, analyze and report data remain in place and are growing even more demanding. It will be more important than ever to be able to predict and manage revenue flow. There are an increasing number of opportunities for healthcare organizations to get more value out of the data in their electronic health records (EHRs).


Healthcare organizations should be proactively evaluating how they can be even more efficient, thinking strategically about how to comply with new advanced alternative payment model requirements and maximizing the associated revenue opportunities.

Comments 1

  1. Debra Volcko 05/22/2017

    We are still seeing just as many if not more uninsured and underinsured patients in our office as we did before the affordable care act. The ones that have managed to keep insurance are paying considerable more in premiums for less coverges. The deductibles have doubled or even tripled in order to keep affordable insurance. Many have found it is cheaper to pay at time of service and get a prompt pay discount which is usually less than the insurance companies have negotiated. We save money by not having to file claims and send statements so we can pass the savings on to the patient.

    I would really like to know where the % of patients helped by the affordable care act come from. We all know that numbers can be manipulated to show what ever we need them to.

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