Care Act – proposed alternative to ObamaCare – would keep Quality Outcome provisions of the ACA

In a Footnote, GOP Gives Up Total Obamacare Repeal

Care Act – proposed alternative to ObamaCare – would keep Quality Outcome provisions of the ACA

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In a buried footnote, Congressional Republicans this week formally acknowledged they’re no longer trying to repeal all of Obamacare. Though the shift represents a narrowing of focus more than a fading of ferocity, it could have significant policy implications, even though a media and pundit focus on politics alone has left them unexamined.

The tactical retreat was quietly inserted into the alternative to the Patient Protection and Affordable Care Act (ACA) unveiled by three GOP senators the day before the State of the Union Address. The Patient Choice, Affordability, Responsibility and Empowerment (CARE) Act retains the requisite war cry: Title 1 is “Repeal the President’s Health Care Law.” Other provisions are mostly a reprise of a well-worn wish list: modest subsidies to encourage the purchase of health insurance; incentives for high-deductible health plans; doctor-friendly malpractice reform; and erasing the Medicaid expansion.

What’s missing is more interesting, starting with that footnote a casual reader might miss. (I did until it was pointed out to me.) There at the bottom of page one, in lighter type and a smaller font, the footnote explains that all provisions are repealed “except for the changes to Medicare.”

While a few media reports mentioned this phrase, no one seems to have asked the obvious question: what changes, exactly, are involved, and how significant are they? I’m not a lawyer, but when I look at the ACA, the reprieve from repeal seems to include a long list of initiatives that are fundamentally reshaping the organization and delivery of medical care to every American.

In other words, the political spotlight remains where it’s been for over a century, on health insurance. Meanwhile, the issue of the safety, effectiveness and timeliness of the actual medical care each patient receives is back in the political shadows. And it’s not just the elderly who are affected. Because Medicare accounts for such a large share of doctor and hospital income, its rules and regulations eventually affect everyone.

To be sure, the GOP footnote mentions Medicare reforms being backed by Sens. Orrin Hatch (UT), Richard Burr (NC) and Tom Coburn (UT), the three authors of GOP replacement proposal. Certainly, the two parties have substantive differences. But in the small print of the Patient CARE Act, Medicare reform has now been given safe passage away from the Tea Party’s anti-Obamacare Holy War and back to the normal political give-and-take.

Which is only appropriate. As I’ve written previously, most of the ACA provisions that aim to improve care have had bipartisan support for years. One 2010 House bill, for example, mandated “standards of quality [and] performance measures” that physicians must meet or risk exclusion from federal health programs and a monetary penalty. That same year, another House bill called for quality measurement, public data reporting and pay linked to performance. The chief sponsor of the first piece of legislation was House Budget Committee chair Paul Ryan (R-WI). The latter legislation evolved into Obamacare. An ACA program to help seniors needing care remain in their home is a health care goal mentioned in the 2012 Republican platform. Sometimes, a “common sense” reform really is.

Below are a few programs that fall under the heading of “linking payment to quality outcomes under the Medicare program.” They include hospital value-based purchasing and various quality reporting programs for physicians, long-term care hospitals, cancer hospitals and others. Also, programs “encouraging development of new patient care models,” such as accountable care organizations (ACOs) in the Medicare Shared Savings Program. Also, reducing hospital readmissions.

If all that got you really excited, you’re a health policy wonk. If not, you instinctively understand the practical politics behind the anti-Obamacare pullback. The ACA won’t be repealed while President Obama remains in office. Even with a new president and Congress in 2017, many of the proposed changes would be very difficult to accomplish with a law that’s been in effect for years. So ACA opponents and proponents are now engaged mostly in a fight over voter perceptions, with the outside chance that a few high-profile provisions might be modified or derailed. That’s why the State of the Union guest roster included a woman whose ACA coverage saved her from being bankrupted by medical care costs, with President Obama, and a breast cancer survivor who saw her existing plan cancelled, with the GOP.

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