News from Washington, D.C., has been moving at an astonishingly rapid pace recently, as it has been more or less since the moment President Donald Trump first sat at the Resolute desk on Jan. 20.
So, too, on Capitol Hill. After just 17 legislative days, the Republicans pulled the American Health Care Act on March 24, unable to bridge an intraparty divide.
It wasn't an especially well-received bill, even since it was first unveiled on March 6. It was called "a thicket of bad incentives" (former CMS chief Andy Slavitt) and "a dog's breakfast" (New York Times columnist Paul Krugman). Other pundits have called it "mealy-mouthed" (The New Republic) and "a rush-job" (Slate).
And that was before a late-minute scramble to amend and revise the plan in order to placates holdout votes.
Some have even wondered whether the bill itself – which has drawn opposition from nearly every healthcare industry and patient organization, from the American Hospital Association to AARP – was actually meant to be a bust.
"Quietly, the idea that the House bill is designed to fail is percolating around Washington," wrote Ezra Klein of Vox. "I've heard it from a half-dozen people now. The law's construction is shoddy. The outreach has been nonexistent. The hypocritical, hyper-accelerated process is baffling. Nothing about it makes sense."
Leaving aside the cynicism of such a ploy, the bill's mishmash of provisions gave credence to what former House Speaker John Boehner said on stage at HIMSS17 on February 23, his remarks quickly being picked up by hundreds of mainstream media outlets worldwide. Repeal-and-replace of the Affordable Care Act won't happen, he said, because "Republicans have never, ever, not one time agreed what a healthcare proposal should look like. Not once. They will never ever agree what the bill should be."
[Also: John Boehner at HIMSS17: Most of the ACA's framework will stay in place]
Upon the unveiling of the AHCA just 11 days later, statements from some of its main proponents were, shall we say, less than ironclad in their predictions.
It's "tough to put numbers" on a definition of its success, HHS Secretary Tom Price said on Meet the Press. How many Americans will lose coverage? "I can't answer that question," House Speaker Paul Ryan told Face the Nation. "It's up to people." President Trump himself has said: "We're going to have insurance for everybody."
(The nonpartisan Congressional Budget Office reported that AHCA would leave 14 million more people uninsured in 2018 and then 24 million by 2026.)
It's not just the AHCA. Such noncommittal, obfuscatory and, yes, at times simply untrue statements from public officials are emblematic of an administration that has so far been hard to figure when it comes to policymaking.
Many of the IT vendors and hospital CIOs I spoke with at HIMSS17 told me they're waiting for clarity from Washington – wondering just where the winds are blowing for health and health IT with this new and very different administration.
In the meantime, some told me they were flying blind: working on projects that had been planned before Nov. 8, 2016, but also waiting to see just what all the political wrangling and opaque messaging would mean for their investments and strategic planning.
For instance, one asked, will Stage 3 meaningful use go ahead as planned? Secretary Price, after all, has been a critic of the program. "I've had more than one physician tell me that the final rules and regulations related to meaningful use were the final straw," he said during his confirmation hearing. Could he decide Stage 3 is a bridge too far, and opt not to enforce it?
(On the topic of meaningful use: One CIO told me that incoming CMS Administrator Seema Verma's vague answers about it during her confirmation hearing made her question whether Verma was even clear what the incentive program was.)
And what about the Office of the National Coordinator for Health IT? What will its mandate be in this new era, and what level of support will it enjoy?
ONC still does not have a leader appointed under the Trump administration and is operating under a continuing resolution, which limits its authority and appropriations to do work on new projects such as the interoperability provisions of 21st Century Cures. What’s more, the creation of the new HHS deputy assistant secretary for health technology who has said ONC "may be reorganizing" has sparked even more questions about the agency's fate.
[Also: HHS names secretary for health technology]
At least the larger notion of value-based care seems more or less secure. Price, in past comments has shown himself to be less than enamored of certain aspects of accountable reimbursement, such as bundled payments. But the fact that the 66-page AHCA keeps its sights set on health insurance mechanisms and subsidy structures, rather than the delivery system reform imperatives inherent in the ACA, seems to suggest that initiatives such as ACOs and value-based purchasing, at least, will be sticking around.
On so many other questions, large and small, healthcare and technology decision-makers are still looking for more to hang their hats on. They work hard to improve care with IT every day, and they deserve honest, well-considered and well-communicated policies from Washington to guide their efforts across the industry.
Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com
