In December 2016, the House of Representatives, and then in due course the Senate, overwhelmingly passed each of their versions of the 21st Century Cures Act, an expansive medical funding bill that bolsters biomedical research and streamlines the Food and Drug Administration’s approvals process for new medicines and medical devices.
The far-reaching medical innovations bill passed the House on a vote of 392-26 and in the Senate 94-5, quickly landing on the desk of President Barack Obama, who signed it on December 13, 2016.
Landmark, bipartisan legislation is a rarity on Capitol Hill, and this bill was two years in the making, heavily lobbied on both sides of the aisle by a myriad of advocacy groups and industry experts. With the din of the repeal and replace dialogue increasing daily and national healthcare policy poised to shift to a Republican-controlled agenda, it is important to acknowledge this bill as healthcare reform progress.
Republican Senator Lamar Alexander of Tennessee was co-author of the Cures Act, along with Republican Representative Fred Upton of Michigan, Democrat Representative Diana DeGette of Colorado and Democrat Senator Patty Murray of Washington. As reported in The New York Times, Senator Alexander noted the “great lengths” and cooperative due diligence in drafting the legislation.
“The cooperation paid off,” he said, also noting, “The next administration or the next Congress will not be repealing the Cures Act because we have taken the time to work out our differences, and create a consensus of support.”
The issue on many minds now is how healthcare reform will unfold, given president-elect Trump’s campaign promise to repeal the Affordable Care Act (ACA). With the repeal and replacement of Obamacare, a 100-day agenda item for the Trump administration, ACA executive actions planned for day one of the new presidency, and Republicans in congress already taking first steps to repeal the healthcare law through budget reconciliation, the bicameral support for the Cures Act was purposefully short-lived.
While some lawmakers, consumer and patient advocacy groups opposed the Cures Act, the main provisions for the $6.3 billion bill include giant steps forward in medical innovation: $4.8 billion for Vice President Joe Biden’s cancer moonshot, the BRAIN Initiative, and the Precision Medicine Initiative. It also provides $1 billion to fight the opioid crisis, funds mental health treatment, and pushes for the better use of technology in medicine.
The politics of taking credit for milestone legislation is natural, and shuttles between the executive and legislative branches, but the December 2016 vote signaled a level of congressional compromise, negotiation, and determination that is sadly, not seen enough. The resulting enabling legislation is a giant step forward in national healthcare policy.
The question begs: when will lawmakers and advocates find common ground again to advance the healthcare concerns for all Americans, given the Republican plan for the ACA and the complications that will unfold as a result?
Critics of the healthcare law cite rising deductibles for people who do not receive subsidies and restricted networks. However, it has provided coverage for over 20 million people through the individual health insurance exchanges, as a result of the expansion of Medicaid, or from children being able to stay on their parents’ plans until age 26.
In debate is how rushing to repeal, or repealing without an alternative, would cause a healthcare insurance vacuum for over 20 million Americans covered by Obamacare, given that it could take years to implement a replacement or alternative package. Republicans are debating the specifics on how to repeal and replace while leaning on House Speaker Rep. Paul Ryan’s Better Way agenda, a white paper on ACA reform that encourages health savings accounts as a replacement measure, among other changes.
On the same side of the aisle, the “repeal and delay” strategy in discussion is a risky approach to upending one of the nation’s most important industries comprising more than 17 percent of our Gross Domestic Product, impacting tens of millions of Americans. Not so sound economics.
Republicans see Obamacare as “broken” and beyond repair, with repeal as the only next step. President-elect Trump has said “the Dems own the failed Obamacare disaster,” and he is prepared to dismantle the existing health insurance arrangements, causing unnecessary and unmitigated chaos, especially for the 20+ million Americans covered by the healthcare law.
How healthcare will evolve next is unknown. What we do know right now is that the Cures Act underscores important conversations happening nationwide on healthcare priorities. President Obama said of the bill’s passage, “We are now one step closer to ending cancer as we know it, unlocking cures for diseases like Alzheimer’s and helping people seeking treatment for opioid addiction.”
Despite the saber rattling of the Republicans on repeal and replace, there is a definitive trajectory of healthcare progress that will continue long after the ACA is repealed for political purposes.
While President Obama’s recent visit to Capitol Hill to meet with congressional Democrats was symbolic and strategically meaningful, it did not alter the course of the Republicans’ lockstep in dismantling one of his signature legacy achievements. Under fire, Obamacare will soon be reconfigured, but its legacy is that it helped jumpstart delivery system excellence in new and innovative ways for the long term.
In a recent New York Times article about President Obama’s era, reporters Abby Goodnough and Robert Pear wrote that Mr. Obama was very clear about the importance of covering the uninsured, but equally clear “that it also has to be about changing the way care is delivered,” according to Nancy-Ann DeParle, former White House aide who was pivotal in ACA negotiations. As Goodnough and Pear report, a “transformation of American healthcare” has occurred over the last eight years that touches every aspect of the delivery system. They write that this transformation has created “a momentum that could prove impossible to stop.”
This is the anti-political nuance no one saw coming.
While Republicans pontificate on how to repeal Obamacare and develop a strategy on replacing the healthcare law, of note is that the delivery system has already evolved to positively impact every level of care. In 2017, there is a broader focus on prevention for individuals and communities at large; coordinated and integrated delivery systems are products of the quiet revolution in healthcare.
The ACA provided an important framework to control costs and enabled physicians and health systems nationwide to treat patients who otherwise would never have sought care. The law provided disease and illness prevention and management, and in many cases kept the sick from dying. New models of care in cancer treatment, heart surgery, primary care and other services will not just go away with repeal of the ACA.
Despite the progress, the bitter and difficult politics of healthcare financing presides.
On reform efforts, Mr. Obama set specific administration goals on pursuing quality over quantity measures and deliberatively pursued an agenda to transform American healthcare delivery. Goodnough and Pear report that “Mr. Obama believes that basing pay on whether a doctor visit or a medical procedure helps a patient, rather than on how much care the patient receives, will result in better care.” Health systems nationwide have adopted, or are in the process of navigating the best practices of embracing these methods for the benefit of patients, physicians and the healthcare industry—and word continues to spread. This is the momentum, the perchance unstoppable quiet revolution in healthcare that has been set into motion. Repeal of the ACA, even with eventual replacement, will not take that away.
Our next steps in healthcare policy must be to modernize medical and healthcare technology systems especially with electronic health records to reduce costs and ensure 24/7 access; streamline payment systems as we move toward a pay-for-value over volume system leaning on the risk-based model to reward physicians and hospitals; continue to find and fund improvements in healthcare quality and care system delivery; streamline other coordinated care “systemness” approaches; and remove the barriers to care for all Americans.
The business of financing healthcare services is a deeply political issue, but when viewed through the lens of providing the greatest good for the greatest number, it need not be. Just as consensus was found in the bipartisan passage of the 21st Century Cures Act, unity is sorely needed to continue to address healthcare reform in a mature, deliberative and responsible manner.
Given the political wrangling of the ACA repeal and replace effort, when Obamacare is officially addressed in the congress by legislative vote, the achievements in healthcare delivery to date will not be lost, given all that has already been achieved. As a nation we must continue to embrace medical innovation, allow for changing incentives in payment that reward value over volume, and maintain the momentum on progress or healthcare costs will skyrocket, creating a two tier system of healthcare haves and have nots.
This blog post was written by Julia Natasha Watthey, MBA, Vice President of Scott Public Relations.
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