Tom Price may be out as Secretary of Health and Human Services (HHS), but his Sabotage Obamacare Campaign lives on. When the Republicans in Washington tried to quickly get rid of Obamacare, Americans across the country (many who had never complained to their elected representatives before) called their congressmen, attended town hall meetings and rallies, and voiced their overall displeasure with the Republicans’ inferior alternatives (collectively called Trumpcare). We were not fooled by the political propaganda and overt manipulation aimed at silencing us. In the end, we prevailed.
Unfortunately for the healthcare consumer and American taxpayer, the many Medicare cost-saving and quality innovations created under Obamacare (PPACA) have been under political attack by the present administration from day one. The particular act of their Sabotage Obamacare Campaign I want to highlight in this blog is the imminent cancellation of (or modification to) the value-based alternative payment models called bundled payments. These bundled payments deliver “quality over quantity” care and improve healthcare affordability.
Tom Price was able to initiate his Sabotage Obamacare because the Obamacare (PPACA) legislation gave the HHS Secretary wide powers to create the programs necessary to deliver cost-effective, quality healthcare. The writers of Obamacare back in 2010 didn’t foresee that a future HHS Secretary would use the words in the law, “at the discretion of the Secretary”, to destroy the cost-effective, quality healthcare programs that had been created earlier nor that he would do so to forward a political agenda that serves moneyed interests ahead of the American people. This campaign to sabotage Obamacare can only work if the President of the United States condones and encourages it.
Sabotage Obamacare Campaign: Stopping Bundled Payments
The specific HHS action that needs our immediate (October 16, 2017 deadline to comment) attention is the proposed HHS rule change:
Medicare Program: Cancellation of Advancing Care Coordination through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model (CMS-5524-P)
Don’t get bogged down with the arcane title. This 24 page proposed HHS rule, a clear manifestation of the current administration’s Sabotage Obamacare Campaign, is not written for healthcare consumers and American taxpayers to understand. You will not find a handy table summarizing how this proposed rule change will cost in increased taxes, hasten Medicare insolvency, or increase the federal budget deficit. We are not meant to find it online and definitely not meant to act with our comments.
Let me give you one example of how this rule change will affect our pocketbooks. The proposed changes to the Comprehensive Care for Joint Replacement (CJR) Payment Model are estimated (see page 2, third column) to add $90 million to Medicare spending in 2018-2020. This means that taxpayers will have to make up that $90 million in new taxes. This $90 million is only a small part of the total savings that this proposed HHS rule will eliminate in Medicare cost reductions that Obamacare programs are expected to deliver.
This proposed rule change does not question that bundled payments, and other value-based reimbursement models are better in many healthcare situations than the seriously flawed fee-for-service presently in operation across the country (”While we continue to believe that cardiac and orthopedic episode models offer opportunities to redesign care processes and improve quality and care coordination across the inpatient and post-acute care spectrum while lowering spending”). HHS says that the proposed rule change was the result of “careful review”. Secretary Tom Price started his short tenure as HHS Secretary armed with a presidential mandate to freeze all pending regulations from the previous administration and spent the next few months repeatedly delaying (2/17/17, 3/21/17, and 5/20/17) the bundled payments programs until the final proposed rule could be drafted. I question how much of the “careful review” had to do with an actual re-evaluation of the merits (in both healthcare cost and quality) of the bundled payments programs versus simply how much sabotage they do without incurring the scrutiny of those who monitor increases in the federal deficit.
HHS disguises the true intent (sabotage Obamacare) of the proposed rule change with the following vague reasons (found on page 2, second column):
- “We believe that requiring hospitals to participate in additional episode payment models at this time is not in the best interest of the agency or the affected providers.” (what about how it affects the healthcare consumer and American taxpayer?)
- “We are concerned that engaging in large mandatory episode payment model efforts at this time may impede our ability to engage providers, such as hospitals, in future voluntary efforts.” (waiting for healthcare businesses to “engage” in payment innovations that will reduce their incomes and profits while making them more accountable for the care they provide is like waiting for pigs to fly)
- “We also believe that reducing the number of providers required to participate in the CJR model will allow us to continue to evaluate the effects of such a model while limiting the geographic reach of our current mandatory models.” (the pre-Trump HHS didn’t seem to have a problem going forward with enlarged bundled payment models…the only thing that has changed was a new Secretary who hates bundled payments for reasons that have nothing to do with what is best for the American people)
Actions needed to fight this example of Sabotage Obamacare
Healthcare consumers and American taxpayers need to let the people at HHS (and their elected officials) that we are aware and do not like the sabotage Obamacare campaign that is being waged at HHS (and probably other government agencies). Government programs that save taxpayers money and improve quality of care like bundled payments should not be eradicated (or delayed indefinitely) to satisfy the Republican mission to destroy Obamacare from the face of the earth. This proposed HHS rule change forwards a political agenda that puts the financial interests of the healthcare industry ahead of those of the healthcare consumer and American taxpayer. In addition, this proposed rule change will increase the budget deficit, reduce Medicare program savings, and increase the possibility of future Medicare insolvency.
WE, the American people, stopped the “Repeal Obamacare” efforts in Congress, NOT our Republican congressmen! HHS may have the power to forward this blatant sabotage Obamacare rule change, but we don’t have to take it in silence. Our work is not done! If you wish to comment on this proposed rule change, there are still a few days left to comment and make your voice heard. The deadline for comment is October 16, 2017. Click on the “Comment Now!” link found at the upper right-hand corner of the webpage.
Don’t let the Sabotage Obamacare Campaign score an easy win without making your voice heard. I encourage you to multiple our voices by sharing this call to comment with all your friends.