The complicated puzzle of moving past Obamacare

As the Trump Administration enters its second month, one of its key promises to Americans – to repeal the Affordable Care Act – remains unfulfilled as legislators debate the next steps in healthcare reform.

Further reading: Replacing Obamacare not an easy path for new administration

While repeal might be easy, it’s replacement legislation that is proving to be the challenge, according to a pair of former administrators for the Centers for Medicare and Medicaid Services (CMS). At the 2017 Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, Andy Slavitt, who served under the Obama Administration from 2015 through January, and Mark McClellan, appointed by President George W. Bush from 2002 to 2004, debated Congress’ next steps.

Slavitt said that Republicans have criticized the reform law for years, then realized that they were in a position to do something about it and produce better ideas, “but there aren’t that many ideas out there” to enact new legislation. The result is the current environment of Republicans in both the House and Senate working on legislation to replace key elements of the law without doing long-term damage to those who’ve benefitted from it over the past seven years.

Andy Slavitt

“The problem is, if you repeal ACA … you repeal the money too,” Slavitt said. “When you do that, replacing [the law] becomes hard and creates a lot of challenges.”

Slavitt, who described his current status as “unemployed,” said he will shortly announce an opportunity that brings him back to Washington, D.C. Since leaving CMS, Slavitt said, he has continued part of his former role as administrator, touring the country talking to physicians, state governors, corporate CEOs and others to get real-world input on efforts that start in Washington, D.C.

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“I hope to play a part in moving us away from the current high-stakes dialogue [regarding healthcare reform] to a more national dialogue,” he said.

Next: “I think you’ll see a ‘step process"

McClellan, who now heads the Robert J. Margolis Center for Health Policy at Duke University, said the odds are “pretty good” that a repeal and replacement package is passed by Congress and signed by President Trump, but it remains unclear what that actually will look like.

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“I think you’ll see a ‘step process,’ where you have pieces of legislation that eventually add up to significant changes,” he said. “It’s not an easy problem to solve, so I think they [Congress] will be at this for a while longer.”

Mark McClellan

Both Slavitt and McClellan also said that it is possible for both parties to come together for such a solution. The issue, Slavitt noted, is putting behind the politics of the past eight years. “We can’t go through a cycle where you have one party that owns it [the reform law] and another who works to poke holes in it,” he said. “I’d rather take a half loaf that both parties own versus one loaf one party owns.”

No matter what legislation moves forward, they agreed that Medicare and Medicaid are likely in for changes.

Both Slavitt and McClellan voiced support for CMS administrator-designate Seema Verma, noting that she will have excellent support around her when confirmed, a step both saw as a mere formality at this point.

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“[Verma] is exactly the person you want to bring on board if you want to focus on state-based innovation,” said Slavitt. "She will have a phenomenal staff at CMS to assist her.”