Washington Lawyer - January/February 2020 - 35

FEATURE
stakeholder who derives substantial revenue
from Medicare, and who already realizes thin
margins, will struggle as Medicare becomes an
even larger percentage of revenues."
For example, in its 2019 annual report to
Congress that was closely watched by health
system chief financial officers, MedPAC recommended that nurses and physician assistants
adhere to standardized pay categories. It suggested loan repayment and scholarships for
geriatricians to address a shortage of doctors
specializing in aging. It proposed a "value incentive" plan under Medicare Advantage, in which
a small portion of payments would be withheld
to promote lower prices for services. And it
suggested price schedules and arbitration to
help keep drug prices down.
"They're just an incredibly thoughtful body that
recognizes payment trends early on. It seems to
me [that] the role of an organization like that
might be somewhat elevated," Wiley says.

THE REPUBLICAN WAY
At the same time, signaling what lies ahead if
a Republican were to win the White House in
November, President Donald Trump issued an
executive order in October directing the secretary of Health and Human Services to propose
a new regulation enabling Medicare to offer
beneficiaries "more diverse and affordable
plan choices."
The order seeks to promote medical savings
accounts, supplemental benefits, and telehealth
services, and to allow beneficiaries to receive

If all of a sudden the only payer
is Medicare, then there's going to
be a lot more red ink at current
payment rates.
SHEREE KANNER, Hogan Lovells

cash rebates as incentives for seeking value
care, among other changes.
"We are committed to focusing on results
instead of process, empowering patients
to make their own health care decisions,
and unleashing innovation to tackle the
unsustainable rising costs of health care,"
CMS Administrator Seema Verma said in testimony to a congressional panel in October.
"For too long, government health insurance
programs focused on regulating processes,
overwhelming providers with burdensome
rules and paperwork," Verma said. "CMS oversight plays a critical role in improving the quality

One of the big questions that seems to
be unanswered right now is, how do
you get doctors paid appropriately? Or
at least paid sufficiently to keep them in
business or wanting to be in business?
LADD WILEY, Olsson Frank Weeda Terman Matz PC

of care, and our requirements need to be developed and implemented in a way that streamlines regulations and allows providers to focus
on their patients, not their paperwork."
CMS has reduced average Medicare Part D drug
plan premiums by 13.5 percent in the past three
years and projected average premiums for 2020
to be the lowest since 2013 under the Trump
administration's initiative to improve competition, negotiation, and incentives for lower
prices, according to Verma's testimony.
The Trump administration has allowed 13 states
- Alaska, Colorado, Delaware, Hawaii, Maine,
Maryland, Minnesota, Montana, New Jersey,
North Dakota, Oregon, Rhode Island, and
Wisconsin - to apply for waivers to the
Affordable Care Act. The waivers allow for
more pass-through federal funding to implement reinsurance programs that pay insurers
on the exchanges for high-cost claims, charging
lower premiums overall.
Controversially, the administration in 2018
expanded the availability of short-term insurance plans - so-called "junk" plans -
on the exchanges. "These plans are not for
everyone, but for many Americans, access to
short-term, limited-duration insurance may
mean the difference between some insurance
and no insurance at all," Verma told a House
Energy and Commerce subcommittee on
October 23.
A group of seven health care associations and
advocacy groups sued to block the 2018
Trump administration rule expanding the

JANUARY/FEBRUARY 2020

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