‘An in­cre­men­tal ap­proach may be the way we have to pro­ceed’

Modern Healthcare - - NEWS -

Repub­li­can Rep. Tom Reed may have voted to re­peal and re­place the Af­ford­able Care Act, but with that ef­fort now es­sen­tially dead, he’s turn­ing his at­ten­tion to amend­ing the land­mark health law in­stead. Reed co-chairs the Prob­lem Solvers Cau­cus along with Rep. Josh Got­theimer (D-N.J.). The 43-mem­ber bi­par­ti­san panel late last month is­sued a set of leg­isla­tive goals for re­form­ing the ACA. Reed is in his dis­trict in west­ern New York lis­ten­ing to con­stituents dur­ing the Au­gust con­gres­sional re­cess. He spoke with Mod­ern Health­care re­porter Mara Lee. The fol­low­ing is an edited tran­script.

Mod­ern Health­care: What are you hear­ing from con­stituents on fixes to Oba­macare?

Tom Reed: Many of them are very happy that some­one has taken the ini­tia­tive to try to sta­bi­lize the in­di­vid­ual mar­ket­place, and what we’re propos­ing, to a large de­gree, they say is rea­son­able. Over­all, peo­ple ap­pre­ci­ate the fact that we’re try­ing to gov­ern and deal with the prob­lem that we face in the in­di­vid­ual mar­ket­place.

MH: So you’re not hear­ing anger from vot­ers that the Se­nate did not re­peal Oba­macare?

Reed: I think there is some frus­tra­tion from our base. As I tell them, we moved a bill in the House, ob­vi­ously, the Se­nate didn’t (pass one). We’re very prac­ti­cal peo­ple in up­state west­ern New York. An in­cre­men­tal ap­proach may be the way we have to pro­ceed, and they’re open to it.

MH: You say spend­ing and fore­gone rev­enue would have to be paid for. Are you mak­ing an ex­cep­tion for cost-shar­ing re­duc­tions, since the gov­ern­ment has al­ready been spend­ing that money and so that does not in­crease the deficit?

Reed: Yes. The cost­shar­ing pay­ment score is zero, ac­cord­ing to the Con­gres­sional Bud­get Of­fice, but when you get

to the em­ployer man­date re­lief, you get to the med­i­cal-de­vice re­peal, (and $57.5 bil­lion in state sta­bi­liza­tion funds) the pro­posal is any­where from $200 bil­lion to $250 bil­lion over 10 years. The off­sets are pri­mar­ily Medi­care pay­ment pol­icy re­forms, as an il­lus­tra­tive list, not a black and white list. There’s a cred­i­ble way to make sure that this is paid for, and we rec­og­nize that there is sig­nif­i­cant cost to what we’re do­ing.

MH: What Medi­care re­form pro­pos­als are you talk­ing about?

Reed: Pro­mot­ing gener­ics in fed­eral med­i­cal pro­grams, the bun­dled- pay­ment pro­pos­als are on there, to try to con­tinue that trans­for­ma­tion of re­im­burse­ment poli­cies to re­ward qual­ity and value, rather than just fee for ser­vice. ... the bad­debt pro­posal that can be dialed, in or­der to gen­er­ate some sav­ings.

MH: Have you heard from any doc­tors or hos­pi­tals since you’ve been back in the dis­trict on th­ese ideas?

Reed: Any time we get into re­im­burse­ment-type de­ci­sions, ob­vi­ously, there’s a lot of con­cern, but I be­lieve they do ap­pre­ci­ate the fact that we’re try­ing to do some­thing and not just get bogged down in the grid­lock, not get stuck in the us-ver­sus-them type of men­tal­ity that has led us to where we are to­day.

MH: What re­vi­sions to 1332 waiver guid­ance would be help­ful in your view?

Reed: When it comes to 1332, that is the abil­ity of states to ap­ply for a waiver, one of the reg­u­la­tory re­forms that I see is not hav­ing to go through state leg­is­la­tures in or­der to get to the fin­ish line, but just have the gov­er­nors and the in­sur­ance com­mis­sion­ers be in a po­si­tion to make the ap­pli­ca­tion.

MH: If the full Se­nate passes a bill fund­ing CSRs and mak­ing tweaks to the 1332 process, do you think the House would fol­low within a month or two?

Reed: Once the Se­nate acts, then im­me­di­ately, you’re go­ing to see a tremen­dous amount of pres­sure on the House to strongly con­sider that leg­is­la­tion as soon as pos­si­ble.

MH: What re­sis­tance have you and other Prob­lem Solvers Cau­cus mem­bers got­ten to this ef­fort?

Reed: They’ve been ridiculed; they’ve been at­tacked; they’ve been threat­ened. The ones that are op­posed to this type of in­cre­men­tal ap­proach want to main­tain this kind of di­vi­sion.

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