Policy Prognosis–Will 2018 Be Another Wild Ride?

We’re now a month into 2018.

Congress rang in the New Year with a massive tax overhaul and a government shut down over immigration. That temporary fix ended in another (very brief) government shutdown before the U.S. House of Representatives voted 240-186 to pass a massive budget bill that had already cleared the Senate. In the early morning of February 9, President Trump signed the budget legislation into law.

Only a month in, it appears we’re in for another unpredictable year in Washington.

Looking back to 2017, ACCC spent much of our advocacy energy on significant shifts in outpatient policies from the new Administration, including sweeping reimbursement cuts to Part B drug payments to 340B hospitals and a continued push towards equalizing payments between outpatient and physician office settings. In the 2018 Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) reduced payments to new off-campus outpatient facilities to 40 percent of OPPS rates. In the meantime, the Department of Health and Human Services (HHS) continued its push to tie Medicare reimbursement to quality and value with the updates to Quality Payment Program (QPP) for 2018 that granted more flexibility for clinicians (i.e., more exemptions and permission for providers to report in virtual groups) but also moved up the timeline for clinicians to be held accountable for the cost of care they provide their patients. ACCC has been focused on ensuring that the implementation of the QPP is appropriately flexible and financially workable for clinicians, and this remains an ongoing priority in 2018.

What else can we expect to see in 2018?

In January, Alex Azar was sworn in as Health and Human Services (HHS) secretary, fueling new speculation about what we’ll see in healthcare in the coming year. Unlike his predecessor, Secretary Azar is not a clinician. We’re unlikely to see the same commitment to flexibility and reduced administrative burden for providers that we saw under the leadership of Tom Price.

In his confirmation hearing testimony, Secretary Azar indicated that he is not opposed to mandatory demonstration programs, and so we may be seeing more of these from CMMI to advance the Administration’s goals. Secretary Azar’s background in the pharmaceutical industry has also fueled speculation that the Administration’s proclaimed commitment to drug pricing reform – the details of which have been unclear at best – may gain some traction under Azar’s leadership, who has noted that drug prices are “too high.” The new Secretary has also said he is opposed to government negotiation of drug pricing, but not against some form of third-party negotiation in Medicare Part B (similar to pharmacy benefit managers in Medicare Part D). Whether Part B reimbursement will be a hot topic in policy (again) this year is unclear, but, as always, it’s wise to buckle your seatbelt.

The debate around the 340B Drug Pricing Program is also expected to heat up in the coming months, recently gaining traction in Congress on the heels of CMS finalizing a policy to reduce Part B drug payments to 340B hospitals by nearly 30 percent. The House Energy and Commerce Committee released a report calling for more transparency and reporting from providers, and for Congress to give HRSA the authority and resources it needs to oversee the program. Meanwhile, two different bills have been introduced – one in the House and one in the Senate – that would place a moratorium on new entities entering the 340B program, establish new reporting requirements for current 340B providers including drug acquisition costs and revenue, and require that HRSA promulgate new regulations that clarify the program. In September, ACCC released principles for 304B reform that also call for more clarity from HRSA to better refine and sustain the drug pricing program. Added to all of this, the American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and America’s Essential Hospitals are pursuing their lawsuit to prevent CMS from enforcing the reductions to 340B hospitals in 2018.

Where does all this leave the Affordable Care Act in 2018?

As you remember, at the end of 2017 Congress repealed the ACA individual mandate. This will almost certainly drive up premiums on the exchanges in 2019 and create an imperative for some sort of market stabilization legislation in 2018. While some members of Congress seem committed to continuing their fight to repeal the full law this year, others, including Senate Majority Leader McConnell, are intent on “moving on” to other issues including immigration and entitlement reform. Despite disagreements over full repeal, expect the Administration to continue to use the regulatory pathway to weaken the ACA, including allowing less comprehensive, cheaper health plans on the exchanges and continuing not to fund the Cost-Sharing Reduction (CSR) payments that insurers rely on to help pay for the costliest patients on the exchanges. Additionally, expect big changes to Medicaid programs this year. CMS Administrator Seema Verma has expressed a strong interest in giving states more flexibility to administer their Medicaid programs, which will mean more state waivers to impose work requirements and lock-out periods as a condition of eligibility and, in turn, a significant impact on Medicaid coverage and access.

Make Your Voice Heard

About one month from now, ACCC members will head to Capitol Hill to meet with lawmakers about their cancer programs and their patients and tell the story of how these policies will affect their access to quality cancer care in their local communities and states. Join us on for ACCC Capitol Hill Day on March 14 – make your voice heard! Learn more and register.