Trump's Plans for the Affordable Care Act, Medicare and Medicaid Taking Shape
Question: What do the nominations of Tom Price and Seema Verma signal in terms of potential policies going forward?
Answer: President-elect Donald Trump’s nominations of U.S. Rep. Tom Price to be HHS Secretary and healthcare consultant Seema Verma to head the Centers for Medicare & Medicaid Services signal the intention to repeal and replace the Affordable Care Act, overhaul Medicare and give states more control over Medicaid.
Price is a vocal and staunch critic of the ACA and has put forward his own replacement plan in the form of the Empowering Patients First Act. The plan involves age-adjusted tax credits to help people buy insurance as well as increased reliance on health savings accounts and high-risk pools at the state level. It allows people to opt out of Medicare, Medicaid or Veterans Affairs benefits and receive the tax credit to buy an individual plan. The plan has not been reviewed by the Congressional Budget Office, though, and critics warn that the plan would fail to keep pace with inflation and force higher out-of-pocket costs like deductibles and co-payments.
Verma is highly experienced in Medicaid regulations and expansion efforts under the ACA. Verma’s consulting firm worked closely with Indiana Gov. Mike Pence to design Indiana’s Medicaid expansion under the ACA. Under Indiana’s unique Medicaid expansion, covered people are required to make a small monthly payment to access health insurance; however, one missed payment can result in a six-month lockout from insurance coverage. Although such punitive provisions are not traditionally allowed by Medicaid, Indiana obtained a federal waiver to implement them. Critics call the provision denying care as punitive and contrary to public health policy as it reduces access of care to Medicaid recipients.
When a physician employs a treatment regime, the physician should delineate clearly, the goals of the treatment. Once that is done, the physician should follow up with how the patient is following the treatment regime and what progress is being made. Charts stating “the patient is improving”, do not cut it. Quantify the improvement. How many minutes can the patient work without pain? How many blocks can the patient walk prior to fatigue? Can the patient tie his shoelaces by himself now? You get it!
This is the level of detail that keeps the bad guys away. Until next time.
- Larry Kobak, DPM, JD
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