Slavitt wants to see bipartisan pathways to bringing down costs while improving value, and argues that Medicare’s new physician payment rule - the most sweeping initiative during his two-year tenure - will be instrumental by rewarding doctors for high-quality, low-cost care. “If we are having a rational debate over risk pools versus reinsurance, that’s where Washington should be on policy issues.” He’d prefer reinsurance programs supporting insurers who cover sicker patients.īut “that’s a rational debate,” Slavitt said. For instance, he thinks high-risk pools promoted by the GOP “are a terrible idea” for insuring the most vulnerable. His goal is now to protect as much of coverage as possible, while understanding that the next iteration will include some of the free-market ideas and state flexibility Republicans favor. The Republican Senate never confirmed him, so he remained “acting administrator.” But they never went on the attack against him in a big way either. His pragmatic problem-solving (he dislikes the word “technocrat”) approach helped him build good ties with much of the health care industry and many governors, including those in red and purple states. He said people like him leaving an administration usually take three months to figure out what’s next - but “I’m going to violate that because of where we are with the ACA.”Īnd where Obamacare stands, in his view, is precarious - but not hopeless.Īs CMS administrator, he was able to work across the aisle, though quietly, more than some predecessors. And he won’t lobby or run for office, he said. But he won’t go back to Optum, the Minnesota-based health tech and consulting company owned by United Healthcare. Slavitt, who will spend much of his time in Minnesota where his family remained while he ran CMS, hasn’t finalized (or won’t say) where he will set up shop in Washington. Much of the policy world understands that it’s not so easy to dismantle a nearly 7-year-old law that, like it or not, has reshaped the $3.2 trillion American health care system and touched millions of families - including the vast number of Americans who may not directly get insured through Obamacare but still benefit from its protections for people with pre-existing conditions. His political base wants Obamacare repealed immediately. Trump is still navigating treacherous crosscurrents. “I want to take him at his word that he truly wants to expand coverage, that he wants to do something bipartisan,” said Slavitt, whose former agency also oversees Medicare and Medicaid programs covering more than 120 million Americans. Friday’s executive order didn’t answer either of those questions. What that coverage will look like - how broad the benefits and how affordable the cost - is still the big unknown. Trump himself has said contradictory things about health care, lambasting the “disastrous” Obamacare while also promising to preserve coverage for 20 million people. That need for clarity may step up pressure for a bipartisan solution, particularly given the rising number of Senate Republicans - including influential voices like HELP Committee chairman Lamar Alexander - who have said they are worried about repealing Obamacare without a workable replacement in hand. But markets are only as good as people’s belief in them.” “I spent two years trying to create stability and predictability for the market - and we did. The market for people who buy their own insurance could implode if the mandate is struck or if health plans, doctors and hospitals abandon the marketplace because they just don’t know what’s next. The uncertainty puts the health care law in jeopardy. Obamacare supporters were officially put on notice just hours after Trump took the oath of office when he signed a broad but imprecise executive order giving his agency heads, such as the IRS and HHS, discretion to stop enforcing key pieces of Obamacare, including the individual mandate.īut Trump’s order doesn’t spell out what his new administration will actually unravel or when, which leaves it as a constant theoretical sword dangling over Obamacare. ![]() His work with industry and government players would unfold as consumer advocacy groups and more traditional Democratic allies stir up the grass roots to protect the health care law that’s covering some 20 million American.
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