Trump, GOP Could Use ‘Must-Pass’ Bills to Bring Health Care Changes

Congress faces several Affordable Care Act issues in 2017

Throughout the campaign, President-Elect Donald Trump’s only health message consisted of promising to repeal the Patient Protection and Affordable Care Act (PPACA). That remains difficult, however, with Democrats still having enough power in the Senate to block the 60 votes needed for a full repeal, according to an article posted on the Kaiser Health News (KHN) website.

In the short term, Trump could use his executive power to make some major changes on his own, the article says. Beyond the PPACA, he also could push for some Republican perennials, such as giving states block grants to handle Medicaid, allowing insurers to sell across state lines, and establishing a federal high-risk insurance pool for people who are seriously ill and unable to obtain private insurance. But those options, too, would likely meet Democratic resistance.

The next Congress and the new administration will be required to address several health issues in 2017, and those could provide a vehicle for other sorts of health changes that might not be able to clear political or procedural hurdles on their own, according to the KHN article.

If the GOP can’t repeal the PPACA and Trump turns to Congress to address some of the issues associated with it, it’s not clear whether the executive and legislative branches could work together to respond to rising insurance premiums, declining insurance-company participation, or other consequences of the act. Nevertheless, some aspects of the PPACA are unavoidable next year. For example, in 2015 Congress temporarily suspended or delayed three controversial taxes that were created to help pay for the law.

One of those taxes, a fee levied on health insurers, was suspended for 2017, while a 2.3% tax on medical devices was suspended for 2016 and 2017. Both industries lobbied heavily for the changes—arguing that the taxes boosted the prices of their products—and would like to permanently kill the taxes.

Also on hold is the most controversial PPACA tax of all, the so-called “Cadillac tax,” which levies a 40% penalty on generous health insurance plans. The idea is to prevent consumers who pay little out of pocket because of their coverage from overusing health care services and driving up overall health costs. The Cadillac tax was technically put off from 2018 to 2020, but experts say pressure will begin to mount next year for reconsideration because employers will need a long lead time if they are to change benefits to avoid paying it. While economists are virtually unanimous in their support for the tax on high-end health plans, both business and labor strongly oppose it.

Also expiring in 2017 is the authority for the FDA to collect “user fees” from makers of prescription drugs and medical devices. The Prescription Drug User Fee Act (PDUFA) was passed in 1990 to speed the review of new drug applications by enabling the agency to use the extra money to hire more personnel. The user fees were later expanded to speed the review of medical devices (2002), generic versions of brand-name drugs (2012), and generic biologic medications (2012).

The PDUFA gets reviewed and renewed every five years, and its “must-pass” status makes it a magnet for other changes to drug policy, according to the KHN report. For example, in 2012 the renewal also created a program aimed at addressing critical shortages of some prescription drugs. Earlier renewals also included separate programs that gave pharmaceutical firms incentives to study the effect of drugs in children.

Some policy-watchers think that, in 2016, the bill could serve as a vehicle for provisions to help bring down drug prices, although it is not clear how well many of the current ideas would work.

Another issue that might come up is a controversial cost-saving provision of the PPACA called the Independent Payment Advisory Board (IPAB). The board is supposed to make recommendations for reducing Medicare spending if the program’s costs rise significantly faster than overall inflation. Congress can override those recommendations, but only with a two-thirds vote in each of the House and Senate.

So far the trigger hasn’t been reached, KHN says. That’s fortunate because the board has turned out to be so unpopular with both Democratic and Republican lawmakers that no one has been appointed to serve.

The lack of a board, however, does not mean that nothing will happen if the requirement for Medicare savings is triggered. In that case, the responsibility for recommending savings will fall to the secretary of Health and Human Services. Medicare’s trustees predicted in their 2016 report that the targets will be exceeded for the first time in 2017. That would likely touch off a furious round of legislating that could, in turn, lead to other Medicare changes, according to the KHN article.

Source: Kaiser Health News; November 9, 2016.