How Trump and the Cabinet he selects will interpret these longstanding principles is another question, and healthcare policy and payment reform experts caution that the answer won't become clear until well into 2017 or beyond.
Eliminating the ACA in its entirety, as Trump promised during the campaign, would mean axing the CMS Innovation Center, which was established under the law and through fiscal 2019.
Its purpose is to test “innovative payment and service delivery models to reduce program expenditures … while preserving or enhancing the quality of care.” As such, the Innovation Center has fostered accountable care organizations, implemented voluntary and mandatory bundled-payment programs and rolled out a . HHS says enrolled in Medicare, Medicaid and CHIP have gotten care through the models.
The Innovation Center is one of the leading entities looking at the viability of healthcare programs and their costs, said Mike Thompson, the president and CEO of the National Alliance of Project Japan Purchaser Coalitions. “My sense is that the CMS Innovation Center is aligned with both sides of the aisle,” he said.
Some Republicans have criticized the Innovation Center's recent moves toward mandatory demonstrations, particularly its effort to change how Medicare Part B pays for drugs administered in doctors' offices and hospital outpatient departments.
But Democrats and Republicans alike have indeed recognized the need to lower costs and improve the quality of healthcare delivery. The Bipartisan Policy Center, for instance, last year by former Senate Majority Leader Tom Daschle, a Democrat, and former House Speaker Newt Gingrich, a Republican whose name has been floated for Trump's Cabinet.
The report recommended that states “advance new and innovative approaches to health insurance coverage” by taking advantage of different components of the Affordable Care Act, including models tested by the CMS Innovation Center. The report broadly acknowledged the need for expanding coverage and improving the value of healthcare by lowering costs and improving quality.
Citing this type of bipartisan support, Blair Childs, senior vice president of public affairs at healthcare improvement company Premier, predicted that “calmer heads” would prevail and preserve the Innovation Center. Its budget might be reduced, he said, but both sides of the aisle recognize its work as necessary.
“The reality is, Medicare needs to be reformed,” Childs said. “So you need some mechanism to test and scale new models in fee-for-service Medicare. And so I think CMMI will in the end survive.”