What will replace the Affordable Care Act?

Bob GattyPresident Trump’s campaign promise to “repeal and replace” the Affordable Care Act (ACA) has proved to be easier said than done as Republicans who control Congress have been unable to devise a workable and acceptable replacement for the controversial health care law.  

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In early February, President Trump told Fox News that his administration may not finalize its replacement plan until sometime in 2018. While many conservative Republicans continued to urge repeal, even without a replacement in place, at least six Senate Republicans said they would not vote for repeal without replacement legislation ready to roll, for fear of leaving 20 million Americans uninsured and concern about ending key ACA coverages, such as protection for consumers with pre-existing conditions.

“At this point, all we know is that something is going to happen to the ACA, but we don’t know exactly what that will be,” said Jeff Frankel, MD, health policy chair for the American Association of Clinical Urologists (AACU). “But we certainly hope there will be some regulatory reforms. The current situation will make it extremely difficult for small practices to continue unless there are modifications.” He was referring to meaningful use requirements for electronic health records and advance payment modifications under Medicare.

Complicating the ACA replace-and-repeal scenario, which has concerned and confused insurers and providers alike, have been other Trump edicts via executive order, such as his original immigration order prohibiting entry into the U.S. from seven predominantly Muslim countries. That order was ultimately overturned by a federal appeals court, but President Trump said he was considering issuing a revised travel ban. The AUA issued a statement expressing concern about the original order’s impact; read it online at bit.ly/AUAimmigrationstatement.

Next: USPSTF reform bill reintroduced

USPSTF reform bill reintroduced

Meanwhile, organizations representing urology continued their push on such key issues as reforming the U.S. Preventive Services Task Force (USPSTF), which recommended in 2012 against routine PSA tests for men.

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The AUA, LUGPA, and the AACU all are urging Congress to approve the USPSTF Transparency and Accountability Act of 2017, introduced in January by Reps. Marsha Blackburn (R-TN) and Bobby Rush (D-IL). The bill, reintroduced after failing to win approval in past years, calls for significant changes in the USPSTF and the process by which it makes formal recommendations regarding preventive care services.

The USPSTF is an independent panel of private-sector experts in prevention and primary caresponsored by the Agency for Healthcare Research and Quality. Its recommendations were linked to insurance coverage by the ACA, resulting in the USPSTF determining what preventive health services health plans must provide without cost sharing.

“There has been concern regarding a number of USPSTF recommendations and their effect on limiting access to preventive care for Americans,” a Jan. 13 AUA statement said. “Therefore, it is important to ensure that the USPSTF implements procedures that allow for meaningful input on recommendation development.”

Of course, should Congress repeal the ACA, the provision linking insurance coverage to USPSTF decisions, presumably, would be deleted-unless it was picked up by replacement legislation.

“We would like to have the provisions dealing with the USPSTF completely removed from the ACA, regardless of whether it is simply modified or replaced,” Dr. Frankel said.

The Blackburn-Rush bill, the AUA said, builds upon and codifies recent USPSTF efforts to be more transparent, including to:

• publish research plans to guide its systematic review of evidence and new science relating to the effectiveness of preventive services

• make available for public comment reports on such evidence and recommendations

• codify the grading system so it cannot be changed without an appropriate review

• establish a preventive services stakeholders board to advise it on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services

• ensure that Medicare or other payers cannot deny payment for a preventive service solely based on the task force grade.

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The AUA testified last November before the House Energy & Commerce Committee, urging approval of this legislation. To advance it in the new Congress, AUA representatives have been meeting with lawmakers urging their support and can be expected to carry that same message to lawmakers during the Joint Advocacy Conference in Washington, March 5-7.

Next: Sec. Price considered ally in reform efforts

Sec. Price considered ally in reform efforts

New Health and Human Services Secretary Tom Price, MD, an orthopedic surgeon and former Republican congressman from Georgia, has opposed many of the task force’s recommendations and is considered by many to be an ally in the reform effort. Urology organizations welcomed his nomination, hoping his experience as a physician will result in favorable health care policies.

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Other ACA provisions that could be eliminated by the law’s repeal could include:

• the Open Payments database, which records industry payments to physicians for consulting, research, and other purposes

• a ban on lifetime limits on physical or mental health coverage

• the Medical Health Home Option, which allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions

• closing the prescription drug “donut hole,” which has reduced the amount that beneficiaries must pay out of pocket under the Medicare Part D program

• increased federal funding for anti-fraud efforts and higher penalties for those convicted of fraud, as well as enhanced access by law enforcement to Medicare claims so they can detect fraud.

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