DaVita’s misdeeds | Anne Rote | Why the GOP is struggling with “Replace”

For those of us that experienced the ACA debate in 2009, the current “repeal and replace” debate is oddly familiar. But, what’s next is anyone’s guess as the long-awaited Republican alternative is quickly taking on water from all sides.

Meanwhile in Austin, the Legislature is focused on the budget — with an eye on opportunity for Medicaid flexibility from DC — as well as a handful of health policy bills with broad support. That’s all part of 5 Things We’re Watching in Texas health care this month.

1. DaVita getting the wrong kind of attention

You would think if a leading national provider of an important health care service, like kidney dialysis and related care, was being regulated, investigated, and sued it would be big news, right? We’re surprised by the lack of coverage looking at the multiple arenas where DaVita is in the crosshairs by CMS, the Department of Justice, and investors, so we pulled it all together in a comprehensive look at their latest potential misdeeds.

“Latest” because DaVita has had some notable negative headlines in the past, including massive fines from the Department of Justice for illegal kickbacks and false claims. Given all that, we wonder if these latest troubles will create a  a market reputation for the company that may be tough to overcome.

2.  Video: Anne Rote, Molina Healthcare

Anne Rote is President of Molina Healthcare in Texas, whose business is focused on Medicaid and the individual market. Molina, like other Lone Star State insurers, has a big stake in what comes next in federal health policy.

In this edition of “What They’re Watching,” Anne discusses tracking Medicaid funding both in DC and Austin, as well as the question of the administrative burdens that are an underappreciated cost and consideration for all health plans with the ACA and its potential successor.

3. What you might have missed last month

We were thrilled to have 300 registered attendees at the inaugural Texas State of Reform Health Policy Conference  last month. Thanks to everyone who attended and helped make it successful!

In addition to a short highlight reel, we compiled video of the Keynote Sessions to share with you based on great feedback on those speakers. The Morning Keynote Panel gave what looks to be prescient insight on the 2017 Legislative Session. The American Enterprise Institute’s James Capretta gave an inside look at what to expect from Republicans grappling with the ACA in DC. And “flexibility,” especially for Medicaid, was a key theme during the Afternoon Keynote Panel on what’s next for Texas health care after the ACA.

4. Health policy moves amidst Austin budget battle

The budget continues to dominate the legislative session, with the latest marker being the House’s proposal to tap the Rainy Day Fund, in part to pay for a number of health care-related needs. Despite the looming budget battle between the House and Senate, some pieces of important legislation are moving forward with broad support.

Sen. Hancock’s latest iteration on balance billing legislation, SB 507, is being heard in Senate Business & Commerce today and has a uniquely broad coalition of support. Meanwhile, Sen. Schwertner’s SB 1107 was heard in Senate Health & Human Services yesterday, building on collaborative, out-of-session work led by the Texas e-Health Alliance and Texas Medical Society to find compromise after a years-long debate about access to telemedicine.

5. The rocky road to a post-ACA world

Republicans have campaigned for years on repealing the ACA, back to the Tea Party’s emergence in 2010 and Mitt Romney in 2012. After years of GOP Congressional votes against the law that were vetoed by then-President Obama, Republicans have a President who campaigned on ending the ACA. Yet now, they may not have the votes to get rid of “Obamacare.”

Here’s the problem: neither the politics nor the policy work well for Republicans to find consensus on repealing and replacing the ACA. This was all predictable since the only GOP consensus was repealing, not replacing, the law. “Replace” forces the GOP to address glaring intra-party differences on health policy and related federal spending. A legislative solution may be incredibly difficult to pass Congress absent collaboration with Senate Democrats — where Republicans don’t have a good recent record — and serious engagement from President Trump.