Chandresh Shah

Obamacare Repeal / Replace – Boehner at HIMSS. Not happening?

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So Mr. Boehner, the leading Republican says ‘They’re basically going to fix the flaws and put a more conservative box around it,’

Repeal and replace has been the familiar cry since November. It makes an excellent soundbite. It is not as easy as it sounds though. Republicans have a huge problem on their hands. Their constituents are angry at any suggestion that ACA would be replaced or entirely removed. There are millions who have been helped by Obamacare.

Not only that, healthcare providers, medical equipment companies etc. have made quite a bit of profit since Obamacare.

The biggest problem is that repealing and/or replacing Obamacare is not easy. Republicans have never agreed on a single strategy related to healthcare so far. Making it happen quickly and sail through the Congress is like dreaming. As Mr. Boehner says, post election conversation about rapid replacement was amusing. Most Republicans agree that they want to eliminate ACA, but they have no idea how to do it and they cannot agree on a single strategy. Republicans attending town hall meetings have been facing an angry backlash from their constituents. These Republicans are going to be very uncomfortable supporting a repeal because their political careers are at risk.

It is very apparent that many components of the current Obamacare will be in place. Things like pre-existing conditions or the 26 year age limit will have to be left alone. Even Mr. Obama knows and agrees that this law is not perfect and will need to change. Republicans need to fix the parts that are broken rather than a complete overhaul. This is a very complex law and complexity is never perfect to begin with. It is a process of constant improvement over time.

The elements that Mr. Boehner expects might change, may be that CMS will not dictate to every state how the plans are going to run. If a state wants to run an exchange, the state can run an exchange. The states can control the policies that are offered like they control every other insurance products offered in their states.

What about MIPS, MACRA and meaningful use?

Value-based payment generally had bipartisan support in order to contain healthcare costs. CMS is most likely to continue developing and refining value-based payment models. Most of the proposal under MIPS seems to be budget neutral and therefore are more likely to be left intact.

The Association of American physicians and surgeons has suggested making MACRA voluntary. They had originally suggested repealing however they have gone softer on this position. Majority of the clinicians are forging ahead in preparation of MACRA and MIPS. We all know that nothing is ever final. Some clinicians are sitting on the sidelines hoping that MIPS will go away. It is too early to know what will happen, I have no reason to expect that MIPS and MACRA will go away.

My recommendation is to forge ahead until told otherwise.