DCMedical News: December 20, 2017
DCMedical News
Washington, D.C.
Healthcare, Medical Education
December 20, 2017
Tax Bill Goes Back and Forth
The “Tax Cuts and Jobs Act” passed the House, but with add-ons not acceptable to the Senate Parliamentarian, so will go back today. The conference report is found here, scorecard in the final pages (amounts spent or earned through tax law changes). The Joint Committee on Taxation report on the same subject is found here. The same Committee’s analysis of “distributional effects” (winners and losers by income and filing status) is found here.
Tax swings of over $100 billion 2018-2027:
Change brackets, minus $1.2 trillion (loss of tax revenue); repeal deductions, plus $1.2 trillion (gain of tax revenue); modify standard deduction, minus $720 billion; alternative inflation measure, plus $133 billion; 20% deduction for qualified business/agriculture, minus $414 billion; disallow active pass-through losses, plus $150 billion; bump child tax credit up, minus $573 billion; increase AMT exemption, minus $637 billion; reduce individual mandate tax to zero, plus $314 billion; 21% corporate tax rate, minus $1.35 trillion; limit net interest deductions, plus $253 billion.
Total for individuals: minus $1.13 trillion; total for business: minus $654 billion, but also international business, plus $324 billion. Grand total: minus $1.456 trillion.
Spending:
Also going back and forth is the Dec 22 Continuing Resolution denouement, embodied formally in the 252 pages of HJR 124, found here. (See CHIPs, below.)
PTAC
PTAC (the Physician-Focused Payment Model Technical Advisory Committee) held its first meeting in the big house (downtown D.C., not in Bethesda), yesterday and today.
The meeting featured interesting new proposals on ways of paying for dialysis (a very smart clinical group), and complex chronic care (another smart clinical group, looking for money to support good works).
One member of the panel took the lead in proposing a strategy which had, however, been implicit in the questioning of the applicants. That strategy, simply put, is “Why don’t we centralize this in accord with what Washington or other funders want, rather than what applicants are doing?” The discussion and voting, in other words, was about what the panel wanted, including many things which they had neglected to put in the RFP. The “NIH” (Not Invented Here) phenomenon is, of course, not unique to PTAC or even to government, but also applies to major foundations (looking at you, RWJ).
In any event, another applicant/supplicant group made a pitch to pay for annual wellness visits separately from other same day services at rural health clinics (found here). Panelists complained that appeals for additional reimbursement by stretched providers, even rural ones, did not seem to qualify as “innovations” in payment. Another idea (found here) was payment for chronic hep-C patients in an episode of care model. (In common with the dialysis proposal, the actual cost of drugs figures in calculations and savings.)
CHIPs, FQHCs, Extenders all in Limbo
Just in time to highlight the importance of Medicaid and CHIP enrollment: CMS released its October report, found at https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.
Highlights: “Medicaid and CHIP Total Enrollment . . .
74,246,626 individuals were enrolled in Medicaid and CHIP in the 51 states reporting October 2017 data. 68,284,283 individuals were enrolled in Medicaid and 5,962,343 individuals were enrolled in CHIP. . . Over 16.3 million additional individuals were enrolled in Medicaid and CHIP in October 2017 as compared to the period prior. . . representing nearly a 29 percent increase over the baseline period.”
The next generation: “Nearly 35.7 million individuals are enrolled in CHIP or are children enrolled in the Medicaid program in the 48 states that reported child enrollment data for October 2017. Children enrolled in the Medicaid program and individuals enrolled in CHIP make up over 50.4 percent of total Medicaid and CHIP program enrollment.”
Also in peril: 900 FQHCs, Medicare extender (e.g. therapy caps) and other health programs caught up in the Continuing Resolution debates.
Miscellany
The House and the Administration have settled House v. Burwell, Burwell no longer the defendant. The issue of legislative powers (the House didn’t appropriate C-SR money) is settled by the parties backing off.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com