Meg Marshall, senior director of public policy for Cerner, develops and oversees Cerner's legislative agenda and represents the interests of Cerner and health care IT collaboratives in working with government officials and industry partners.
We're days away from the inauguration of the 45th president of the United States and just over a dozen days into the 115th Congress.
With Washington D.C. abuzz, Cerner is keeping a close watch on actions the new administration will take that impact health care. We've already seen a flurry of movement and posturing related to the repeal of the Affordable Care Act (ACA). With health care a priority for President-elect Trump and the Republican-led Congress, the stakes are high for our clients and the health care industry
- ACA Will Set the Tone for 2017 and Beyond
Republicans have been talking about repeal since the ACA was enacted in 2010. Over the years, Congress has voted at least 60 times on some sort of repeal, and there remain a number of proposals and strategies for how best to dissolve it. Democrats, on the other hand, have rallied around the additional coverage provided under ACA, as well as the law's most popular provisions, like prohibiting insurance companies from refusing coverage to individuals with pre-existing conditions.
The new Congress convened Jan. 3, and the Senate approved the fiscal year 2017 budget resolution just 10 days later. Among other things, the resolution included instructions for Senate and House committees to begin work to repeal major parts of the ACA. The House quickly approved the resolution and the committees have begun their work.
As Congress was approving the budget resolution, Trump called for Congress to "simultaneously" repeal and replace the ACA. This contradictory strategy concerned some congressional leaders, as they hoped to take a step-by-step approach to replace the law. Other lawmakers rallied around Trump's comments, suggesting his timeline would force congressional leadership to rethink their own timeline.
The U.S. has invested significantly in advancing electronic health records to work toward four goals for the health care system
- Improve quality, safety and efficiency
- Engage patients in their care
- Increase coordination of careImprove the health status of the population
- Ensure privacy and security
These goals were established in the Health Information Technology for Economic and Clinical Health Act as part of the American Recovery and Reinvestment Act of 2009 economic stimulus bill, not the ACA. The integral role health IT plays in transforming health is non-partisan, so while we can expect significant legislative and regulatory activities with ramifications for our solutions, services and the overall delivery of health care in the years ahead, we don't expect targeted activity to devalue the role of health IT.
- Where Price Will Take the HHS?
Trump also said the plan for replacement will come once HHS nominee Rep. Tom Price (R-GA) is confirmed. The Senate began confirmation hearings last week, and the process to confirm all nominations will likely last months. Price will testify before the Senate HELP and Finance committees. Some Senate leadership has suggested a vote on his confirmation in the Senate Finance Committee may come mid-February. We expect Price's testimony to shed light on his plans for HHS policy, including what may impact health IT.
- What Executive Orders Trump Will Enact?
It's been reported that Trump will begin dismantling parts of ACA on his first day in office. Vice President-elect Mike Pence told Republican lawmakers the new administration is working on a series of executive orders related to the "orderly transition" between repeal and replacement. While Trump certainly can't rewrite the entire law through executive order, he is able to give binding orders to the heads of federal agencies to direct their execution of policies. The specifics remain unclear as to how Trump will use this tool in his overall strategy.
- Will the Congressional Review Act Be Invoked?
Congress has another tool as its disposal: the Congressional Review Act (CRA). Until mid-May, Congress can use the CRA to review and override major regulations passed at the end of the Obama administration. The CRA has only been successfully invoked once, but this could be a very effective mechanism as Republicans control the White House and both chambers of Congress.
Nearly all HHS rules issued in 2016 related to payment systems and reform fall under this time period, plus a few others like the ONC Enhanced Oversight rule. Regardless of ACA's path forward, health IT will remain important to the progression of value-based care, and there has been no indication that any health- or health IT-related rules would be disapproved by Congress through this process.
- Where Will 2018 Budget Priorities Lie
Looking further out past the inauguration, Trump will deliver his 2018 fiscal year budget proposal in early February. Although this document is heavily focused on numbers, it can provide some insight on the new administration's policy priorities and intentions. Also, the federal government is funded by a continuing resolution through April 28. Before the end of April, funding priorities and levels will have to be debated and a plan formulated to fund the government through September 30, the end of the fiscal year. We may see more effects on health-related policies in the form of this legislative vehicle.
Through all of this ambiguity about the strategy to repeal and replace the ACA, one thing is certain. The pace at which Washington D.C. moves will only pick up after the inauguration, as the new president and Congress are focused on their top policy priorities. Cerner understands the complexity of how policy changes can affect our industry and we will be watching closely, providing input where needed and reading the tea leaves along with all the others. Stay tuned for additional updates, including Cerner's 2017 policy agenda.