WASHINGTON -- Adding 20 million more people to the insurance rolls and having 30% of physician payments tied to value rather than volume are two of the major accomplishments of the Centers for Medicare & Medicaid Services during the last few years, according to CMS acting administrator Andy Slavitt.
"I remember saying to the Secretary [of Health and Human Services] that I wanted to give the president a single-digit uninsured number before we leave," Slavitt said at an event here Thursday sponsored by the Association of Health Care Journalists. He noted that the uninsured rate was now 8.4%. "And we hit that 30% number in January. I would characterize both those things as good starts, but we know what the challenges are."
In terms of coverage, priorities include getting more of the working poor enrolled, as well as those who are in transitional jobs or the "new economy," working on a freelance basis. Covering the working poor "is about Medicaid expansion; when you think about how the law is performing, it was originally intended to have Medicaid expansion in every state," Slavitt said, adding that he was excited about the Medicaid expansion in Arizona that was recently approved by CMS. He said it shows that "it's true you can have conservative principles that are quite acceptable to moving Medicaid forward. I hope no governor wants to surrender the progress we've made to date."
Then there are the "structurally uninsured" -- those who remain uninsured for long periods due to chronic illness or insufficient income. "This is what open enrollment [in the health insurance exchanges] is about in a lot of respects," Slavitt said. "We've got to make a dent in that every year. I'm very excited about open enrollment because I know we're going to make another dent in that this year. Many people are eligible for tax credits and most of them don't know it."
As for those in the new economy, "the Affordable Care Act (ACA) is for those people too," he continued. "The ACA passed because it's good for our economy -- it's the right thing to be able to do to adapt to the way people want to work. People who come into the exchange for 3, 4, or 5 months -- in a lot of cases that is a success."
Then there is reforming the healthcare delivery system, including physician payment. Slavitt compared implementing the physician payment system enacted in the Medicare Access and CHIP Reauthorization Act (MACRA) to introducing smartphone technology. "We've been in the stage of selling people iPhone 1 and iPhone 2," especially those in smaller practices, he said. "MACRA is really an opportunity to run up the adoption curve for community physicians and community hospitals; these are two-doctor, three-doctor, four-doctor practices, and they're all using a flip phone. So it's a big task."
The agency's recent announcement of the Pick Your Pace program, in which physicians have several options for working under MACRA, "should be emblematic of the fact that we want to ... take the long view. Practices are at various stages, and so diverse, that they're going to take different approaches," he told MedPage Today. "That will be thematic throughout how we finalize the policy ... Those paths should include many people having access to many types of models and choosing the ones that are right for them."
What will be on the agenda for the new administration and new Congress in 2017? ACA repeal is one possibility, especially if Republican candidate Donald Trump is elected president and the Republicans control Congress, according to G. William Hoagland, senior vice president at the Bipartisan Policy Center here. Even though ACA repeal has not been a large part of Trump's campaign, "I still think that latent out there is this anti-government, anti-Washington DC sentiment," said Hoagland, who also spoke at the briefing. "Depending on the outcome of the election, it's going to be back."
Then there are more bipartisan issues that Republicans and Democrats might come together on. "There's CHIP [the Children's Health Insurance Program], there's veterans, there's TRICARE; there are things revolving around the issue of healthcare that are not specific to the ACA," said Hoagland. "The 'Cadillac tax,' -- that's going to come up again. I also think long term care issues are going to come back in front in a big way."
Other possibilities for compromise legislation include lowering prescription drug prices, instilling greater healthcare price transparency, and improving competition in the healthcare marketplace, said Neera Tanden, JD, president and CEO of the Center for American Progress, a left-leaning think tank here. "There are spaces where they can start the conversation."