From the 2016 presidential election's potential effect on health reform to the ongoing implementation of the Medicare Access and CHIP Reauthorization Act, American Health Line's coverage in 2016 focused on topics that would most affect U.S. residents and providers. What were the most popular stories among our readers? Look below for American Health Line's top 10 stories of 2016, based on reader visits.
- What does Trump's election mean for the ACA?
The future of the Affordable Care Act (ACA), along with that of several other health care policies, became more uncertain after Donald Trump on Nov. 8 defeated Hillary Clinton in the presidential election. Noting that Republicans do not have a filibuster-proof majority in the Senate, industry observers said Republicans could use the upcoming budget reconciliation process to pursue a partial repeal. However, it remains unclear what the GOP's ACA replacement bill would include, as Trump and Republican lawmakers have yet to coalesce around a single detailed proposal.
Since this story ran on Nov. 9, Trump has shown a willingness to keep certain ACA provisions, including those that allow U.S. residents to remain on their parent's health plan until age 26 and prohibit insurers from denying individuals coverage because they have pre-existing medical conditions. Republican lawmakers also have shown support for some key ACA provisions, but they have yet to provide clear details on how exactly they will go about repealing the law. Some GOP lawmakers say repeal efforts could start as early as January.
- CMS unveils proposed rule for value-based payment programs under MACRA
CMS in April released a proposed rule for new value-based payment programs under the Medicare Access and CHIP Reauthorization Act (HR 2). In the rule, CMS proposed creating a new framework called the Quality Payment Program, which would allow eligible professionals to choose from two quality reporting paths: The Merit-based Incentive Payment System or the Alternative Payment Model. Initial reaction to the proposal was mixed, with some industry stakeholders saying the rule does not give providers enough flexibility and others saying it showed CMS took provider considerations into account.
Since this story ran on April 28, CMS unveiled a final rule that aimed to give providers more flexibility. Many industry groups praised CMS' efforts to reduce clinicians' burdens under the final rule, but some stakeholders said CMS went too far, and that the agency could continue to delay certain requirements in future years.
- House GOP releases policy paper detailing plans to repeal, replace ACA
House Republicans in June released a policy paper, titled "A Better Way," outlining a plan to repeal and replace the ACA. The plan would repeal the ACA in its entirety, including its coverage mandates, exchanges, subsidies, taxes, and other requirements. Instead, the plan would provide all U.S. residents who purchase individual health plans with tax credits to help offset premium costs and make it easier for insurers to sell health plans across state lines. The plan also includes proposals to transition Medicare to a premium-support model and turn Medicaid into a block-grant program. The plan drew criticism from Democrats and other ACA supporters.
Since this story ran on June 22, American Health Line examined the eight ACA replacement plans that are most likely to serve as the foundation for health care reform under Trump's administration. While Republicans have yet to agree on a single plan, two proposals—those offered by House Speaker Paul Ryan (R-Wis.) and Rep. Tom Price (R-Ga.), who Trump tapped to lead HHS —stand out as the main building blocks for a GOP health reform plan.
- Obama admin submits official request for Zika response funds to Congress
The Obama administration in February officially requested that Congress authorize $1.8 billion in emergency funding for efforts to combat the Zika virus. The request came after Republican lawmakers directed federal officials to use uncommitted Ebola funds for Zika response efforts. The administration said the requested funding would be used to accelerate Zika vaccine research and diagnostic test development, bolster mosquito control programs, educate providers—as well as pregnant women and their partners—about Zika, and expand response efforts.
Since this story ran on Feb. 24, Congress after months of debate passed legislation that provided $1.1 billion for efforts to combat the Zika virus. Florida was the hardest-hit state in the continental United States, with officials as of Nov. 22 reporting 1,201 cases of Zika, of which 236 were locally acquired. Texas is the only other state in the continental United States to report a potential local transmission. CDC Director Tom Frieden in a speech in October said a Zika vaccine at best is at least "two to three years" away and lamented the budget constraints the CDC faced while it waited for Congress to approve funding.
- Meet Trump's picks for HHS secretary, CMS administrator
Trump last month said he would nominate Price to lead HHS under his administration and Seema Verma, a health care consultant, to serve as CMS administrator. Price, who is chair of the House Budget Committee and sits on the health subcommittee of the House Ways and Means Committee, has long opposed the ACA. Verma is president, CEO, and founder of SVC, a health policy consulting firm, and is well known for her work on Indiana's Medicaid expansion waiver. Trump in a statement said, "Together, Price and Verma are the dream team that will transform our health care system for the benefit of all Americans." But some Democrats raised concerns about the nominees' positions on key health policy topics. Both positions require Senate confirmation.
- UnitedHealth will exit most ACA exchanges
UnitedHealth Group CEO Stephen Hemsley in April announced plans to significantly scale back the company's ACA exchange business for the 2017 coverage year. UnitedHealth sold coverage through the exchanges in 34 states for the 2016 coverage year, but Hemsley said it would participate in exchanges in just "a handful" of states for 2017. The announcement came after the company reported losing $720 million on individual health plans it sold through ACA exchanges throughout the United States in 2015.
Since this story ran on April 20, the ACA's fourth open enrollment period launched. Despite higher-than expected exchange premiums for the 2017 coverage year, HHS said the Nov. 1 launch was smooth and that more than one million U.S. residents signed up for federal exchange plans during the first 12 days of open enrollment. The open enrollment period started Nov. 1 and ends Jan. 31, 2017.
- Trump vows to repeal and replace ACA 'immediately' if elected
In the week before he won the presidential election, Trump in a campaign speech vowed to repeal and replace the ACA "immediately" if he is elected. Trump said he would convene Congress for a "special session" to repeal and replace the ACA, saying the law raises health insurance prices, while reducing choices and lowering quality. Trump's running mate, Indiana Gov. Mike Pence in a speech preceding Trump's said an ACA replacement plan would include a "transition period" for consumers, particularly those currently enrolled in exchange plans and protections for consumers with pre-existing conditions who switch to a new plan.
Since this story ran on November 3, Republican lawmakers have discussed just what that transition period could look like. So far, there does not appear to be a consensus, with some Republicans saying a two-to-three year transition period is needed to ensure a smooth transition, while others say the ACA should be repealed and replaced simultaneously and that any repeal efforts should wait until the GOP unites around a replacement plan.
- Where Hillary Clinton, the presumptive Democratic presidential nominee, stands on health care
Former Secretary of State Hillary Clinton in June was declared the official Democratic presidential candidate. Throughout the presidential campaign, Clinton put forward several new health care plans, including plans aimed at curbing prescription drug prices and out-of-pocket costs, improving Veterans Affairs health care, and boosting screening and coverage for autism spectrum disorder. Clinton also showed support for implementing new value-based systems and expanding alternative payment models such as bundled payments and accountable care organizations.
- Vt., CMS reach preliminary agreement on all-payer health care model
Vermont in September reached a verbal draft agreement with CMS that allows the state to implement an all-payer health care system. The draft agreement said the new system could help to "reduce Medicare, Medicaid, or [CHIP] expenditures while maintaining or improving quality of beneficiaries' care." It estimated that the new system could save the state about $10 billion over the next decade by limiting health care cost increases to 3.1 percent annually, down from projected increases of about 6.6 percent annually. However, some physicians in private practice expressed concern that the new system would limit Vermont residents' health care choices, while others said it could benefit some larger health care organizations by giving them a monopoly in the market.
- CMS releases ACA risk-adjustment, reinsurance payment details for 2015