ACA’s future hot topic at HIMSS 2017—but HIMSS itself doesn’t take a stance

Many panels at HIMSS 2017 in Orlando included references to the ongoing policy debate over the Affordable Care Act (ACA) and how that’s affecting all corners of the industry. For HIMSS itself, however, it feels health IT is better off staying out of much of the discussion.

In introducing keynote speaker Ginni Rometty, CEO of IBM (who herself mentioned the impact of “political uncertainty” in healthcare in her remarks), HIMSS North America board chair Michael Zaroukian, MD, PhD, said the questions over the ACA lead to larger doubts about the transition from volume to value.

In a later meeting with reporters, Zaroukian said hospitals, particularly those focusing on “the underserved,” may consider shying away from health IT investments if the ACA is repealed, but not replaced.

“That could run into tens of millions of dollars or more for a lot of organizations, which has created some caution among some in that regard,” he said. “But I think we remain understanding and committed to the reality that payment for value is still a key and critical factor, that those who do that will succeed in the end.”

To HIMSS’s vice president of government affairs, Tom Leary, health IT’s priorities will “absolutely continue to be bipartisan” and will play a role when and if an ACA replacement is put into real legislation. To take a stance on the most contentious parts of the repeal-and-replace fight—namely, whether millions of people will lose their health insurance—would be “swimming outside of our lane.”

Leary also indicated to HealthExec that he believes legislation on HIMSS’s wish list for the current Congress won’t get bogged down in more partisan ACA battles, and items like telehealth could be a part of a legislative compromise.

“We anticipate they’re going to bring topics like that into the discussion and not just rip it, you know, repeal and replace,” Leary said. “So that’s why telehealth, cyber and workforce are three very important issues for us.”

Other sessions at the conference were far more direct about the healthcare industry’s concerns. Most notably, former CMS administrators Andy Slavitt and Mark McClellan, MD, PhD, debated the two parties’ perspectives on the ACA (along with Slavitt’s criticism of the health IT industry).

McClellan, who ran both the FDA and CMS during President George W. Bush’s presidency and now directs Duke University’s Margolis Center for Health Policy, said he expects the ACA debate to drag on a while longer, predicting Republicans may have to settle for legislation that technically repeals and replaces the law but, in reality, keeps it more or less intact.

In the short-term, however, he said hospital CEOs should “maybe” consider backing off investments related to the value-based care transition.

“Probably the Medicaid and the like is going to get a bit tighter,” McClellan said. “There might some lessons to learn from states that haven’t expanded Medicaid.”

The week ended with a very ACA-focused discussion with former House Speaker John Boehner. Now out of government, he said he laughed at Republicans’ expectations that the ACA repeal-and-replace strategy would work quickly, saying during his quarter-century in Congress Republicans “never, ever” agreed on what a healthcare reform plan would look like.

He predicted repeal-and-replace is “not what’s going to happen,” but some changes would be passed while keep provisions protecting people with pre-existing conditions and subsidies for people buying insurance.

"What will be different is that CMS will not dictate to every single state how the plan's going to run. And if the state wants to run an exchange, the state can run an exchange. The states will control the policies that are offered like they control every other insurance product offered in their states,” Boehner said.