Election night saw Donald Trump winning the presidential race; an event that is widely touted as the crowning jewel on the car crash year that has been 2016. The morning after was no better as people looked past Trump’s rhetoric to his policies; the most prominent of which was his plan to completely repeal Obamacare.
The Affordable Care Act of 2010 (ACA) has been a source of contention between the Republicans and Democrats under President Barack Obama’s tenure in the White House. Yet it paved the way for the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), a bill that passed with undisputed bipartisan support. Since physicians, and the healthcare industry at large, is currently preparing for MACRA’s first performance year in 2017; many are wondering if the repeal on Obamacare would extend to MACRA.
Would the past year of prep, all the time and money spent, be for nothing?
Healthcare experts like Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, say there is nothing to worry about. There are some aspects of MACRA that are tied in with Obamacare, but MACRA will largely be unaffected by any changes initiated by Trump’s administration. Gilberg also argues that MACRA passed with nearly unanimous bipartisan vote, and has as many supporters in the GOP as it does at the Democratic front.
Anders Gilberg has further explained how the Medical Group Management Association has  always seen MACRA as a “living breathing thing” that will continue to evolve, where changes and adjustments are to be expected, especially in 2018.
“There will always be refinements as we learn more in 2017 and we can expect this administration to be open to simplification, but I don’t think the core is in jeopardy at all.”
The managing director of The Advisory Board, Christopher Kerns agrees that MACRA is safe but may face a move away from accountable care as the main influence for  controlling spending, and shift towards bundled payments or price control, cuts, or other forms of control in the form of reduction in reimbursement for the types of services.
The Center of Medicare and Medicaid Innovation (CMMI), part of ACA, will be one of the main focuses of change according to Kerns. This is because changes made by CMMI are not subject to approval from Congress. Kerns believes it is possible Congress will want to assert more control over their functions, and not allow them as much authority over payment changes but opt for mechanisms that lead to payment cuts.
CMMI has authorization to enact mandatory bundle payments as long as it was  shown to save money without damaging quality. Which a future Congress may be interested in monitoring, and eventually adjusting if expectations are not met.
However, Kerns argues that MACRA is a result of bipartisan reform, and was used to repeal the Medicare Sustainable Growth Rate (SGR), moving physicians towards performance-based payment systems. It would make very little sense for Congress to repeal it now.
As things stand there is very little experts can say right now about the future of Obamacare and its ripple effect on MACRA, but there are three areas they will be looking at closely in the coming months.
First and foremost experts will look at what kind of authority Congress wants to have over payment reform. This will be a good indication of CMMI’s future, and consequentially MACRA’s.
Secondly, what the general view of the new Congress is towards ACOs. Whether Congress choses to use downside risk to control spending, or reimbursement cuts for the future, will be very telling of what healthcare professionals can expect over the next four years.
Thirdly, how much importance Congress places on performance-based incentives and penalties will be crucial to the future of MACRA.
In a recent statement, the American Academy of Family Physicians expressed their belief that MACRA as a whole isn’t in any real danger of repeal.
“The election of Mr. Trump will have a limited impact on the MACRA law in the short-term. The law goes into effect January 1, 2017, before he is installed as president. Looking forward, this bi-partisan law was supported by 91 percent of Congress to bring about long needed value-based payment reform and repeal the flawed SGR. Based on the bipartisan support for the law, It is currently difficult to see how there would be any fundamental changes to the law under the Trump administration,” said AAFP President John Meigs Jr.