By any measure, September was a bad month for President Trump’s healthcare policy agenda.

Having spent most of the month trying to gather support for the Graham-Cassidy Obamacare repeal bill, Senate Republicans abandoned their plan to vote on the bill on September 26th following public opposition to the effort by several key Republican Senators including John McCain (AZ), Rand Paul (KY), and Susan Collins (ME). Then, following a week of revelations and negative press regarding Health and Human Services (HHS) Secretary Tom Price’s use of taxpayer funded private and military jets, the White House announced Price’s resignation late in the afternoon on Friday, September 29th.

As a result, panelists on the October 1st Sunday morning news shows found themselves debating both the failure of President Trump’s top healthcare policy priority and the sudden departure of his top healthcare official. Not surprisingly, this debate cast doubt on President Trump’s healthcare agenda, and subsequently, left many wondering, what comes next?

Next Steps for Congress

Having failed to pass three other repeal bills in July, a legislative repeal of Obamacare appears dead for good this time (for this Congress at least). With the 2017 budget resolution expiring October 1st and the 2018 resolution earmarked for tax reform, any new effort to repeal, revise, or amend Obamacare will require 60 votes in the Senate- an extremely unlikely scenario given the GOP’s inability to find any bill that could garner even 50 votes to date.

Meanwhile, the Senate’s health committee has resumed bipartisan negotiations to reform the ACA’s individual market exchanges ahead of the upcoming 2018 open enrollment period. The President himself expressed an interest in these efforts this past weekend, tweeting: “I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill. ObamaCare is badly broken, big premiums. Who knows!” Given current political dynamics, it remains to be seen whether these efforts will yield a compromise that results in any changes in law.

One area where bipartisan cooperation is expected is on a legislative reauthorization or extension of funding for the Children’s Health Insurance Program (CHIP) and our nation’s community health centers. Funding for both programs- which was originally authorized by Obamacare and later extended by MACRA- expired at the end of September but is still considered a bipartisan “must-pass” priority likely to be addressed before the end of the year.

With Price’s departure, the Senate may also need to find time to squeeze in another round of confirmation hearings if Trump chooses to nominate a replacement for new acting HHS Secretary Don Wright, who previously served as HHS Deputy Assistant Secretary for Health and Director of the Office of Disease Prevention and Health Promotion.

Next Steps for the Administration

Earlier this year, GOP leaders outlined a three-pronged approach to repealing Obamacare: the initial repeal bill, regulatory changes, and additional legislation. With phase one now officially dead, HHS is likely to pursue a more aggressive, phase two regulatory overhaul of Obamacare starting with an Executive Order this week. However, the breadth and impact of any changes remains to be seen, especially with the department’s change in leadership.

Beyond the ACA, the Centers for Medicare and Medicaid Services (CMS) still needs to issue final 2018 regulations for several Medicare payment programs including MACRA’s Quality Payment Program. These regulations are likely to seek a balance between the Administration’s goals of reducing the regulatory burden on physicians, while still embracing the transition to value-based care. Elsewhere within CMS, Administrator Seema Verma recently announced a “new direction” for the Innovation Center (CMMI) as the agency released a Request for Information soliciting stakeholder feedback on what that direction should be.

Implementation of last December’s bipartisan 21st Century Cures Act is also expected to continue with critical regulations implementing legislative provisions related to EHR interoperability and certification expected this fall.

We’ll See

While recent events have created some uncertainty about the future direction of healthcare policy, we do know that for the time being Obamacare will remain the law of the land.  At the same time, the transition to value based reimbursement- which is both politically bipartisan and the result of non-governmental market forces- will continue, albeit likely with a lighter regulatory touch applied to our favorite federal programs, including ACOs and MIPS.

Still, other policy issues will remain unresolved as the Trump Administration and GOP Congress necessarily pivot to the next phase of their healthcare reform agenda. What will that agenda be and who will lead it? As President Trump likes to say, we’ll see.

Impact to Healthcare Providers

In today’s political climate, healthcare providers must realize that further policy changes are unpredictable, yet also inevitable. As such, it has never been more important to partner with a vendor who has the technology, services, and expertise to help guide you through the ever-changing landscape.

NextGen Healthcare remains committed to helping providers cut through the noise of Washington, D.C. and focus on what’s important. To learn more, check out our Heath Reform webpage.