While there is a degree of uncertainty surrounding changes that will be made to the Affordable Care Act by the Incoming Administration, one portion of the Act that has emerged as impervious to change is the Medicare Access and CHIP Re-Authorization Act (MACRA). The primary reasons for this analysis is that MACRA received strong bipartisan legislative support, it is patient centered, it is framed around value based reimbursement, it creates market-based competition and supports the collection and dissemination of data to help consumers make informed decisions on who most likely will provide care consistent with their healthcare goals, values and expectations.
However, based on H.R.2300 "Powering Patients First Act" that was drafted by the incoming DHHS Secretary Dr. Tom Price and the Health Indiana Plan 2.0 that was designed by incoming CMS Administrator, Seema Verma with the support of Vice President Elect Mike Pence, there are several changes that are likely to occur:
Medicaid beneficiaries will be required to pay minor out of pocket costs and demonstrate that they are working to improve their education or income status.
Increase use of Health Savings Accounts for Medicare and V.A. TRICARE.
Block grants for states to support Medicaid with each state given authority to design enrollment and delivery systems that maximize the value of each federal dollar received.
Healthcare Plans will be allowed to sell across state lines to compete for blocks of insurance coverage from small business owners who band together to increase their bargaining power
Tort reform will include State Healthcare Tribunals to adjudicate certain lawsuits and will be enacted to reduce the need of costly defensive medicine by indemnifying physicians who practice evidence medicine supported by consensus-building professional organizations. This will also include provisions of the "I'm sorry" law where a physicians apology for an untoward event is not used as evidence of guilt or liability.
While there is minimal consensus among researchers and prognosticators regarding what the future holds for healthcare post January 20, 2017, there are two principles that have emerged with bipartisan support and as having the most impact for guiding healthcare into the future:
All patients will be asked to become engaged healthcare consumers and help increase market-driven competition by using their healthcare dollars to make informed decisions based on a growing body of published value, quality and safety data
Pay for Value will continue to emerge as the primary reimbursement model for increasing market-driven competition among providers and health plans.
MACRA is the one provision of the ACA that contains the market-driven principles noted above. It has also received strong support from multiple stakeholder and it aligns with the principles that have been espoused by those who will take the helm of Federal Healthcare Programs in just a few weeks.