If the Republican-controlled Congress and incoming Trump administration are successful in repealing the Affordable Care Act, it could affect more than the 20 million Americans who currently have health coverage under the existing law.

That’s the contention of Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, who is warily watching political developments in Washington as President Barack Obama leaves office.

In particular, Tripathi worries about the fact that the Medicare Shared Savings Program (MSSP) was established by section 3022 of the ACA as a key component of Obamacare’s Medicare delivery system reform initiatives. The MSSP serves about 7.7 million beneficiaries across more than 430 Medicare ACOs.

“One of the things that people don’t fully appreciate is that all of the ACOs, like the MSSP contracts and a whole bunch of others—which account for something like 500 of them out in the market—all of those are created under ACA authority,” says Tripathi.

“If you literally repeal ACA without any carve-outs, all of those ACOs are gone because they are under the Obamacare umbrella,” he warns. “No one seems to be talking about that.”

Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.
Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.

The Senate and House last week took the first steps toward repealing Obamacare by passing budget resolutions in advance of President-elect Donald Trump’s inauguration on January 20.

Also See: GOP leaders say Obamacare repeal to advance despite concerns

According to the Centers for Medicare and Medicaid Services, the Shared Savings Program ACOs are groups of doctors and other providers who voluntarily work together with Medicare to give high quality service to Medicare fee-for-service beneficiaries.

“I’m not suggesting that doing away with ACOs is the intent of the new administration. It just might be that they haven’t fully appreciated all of the unintended consequences that could come from repealing the ACA,” adds Tripathi.

Speaking at last week’s JP Morgan Healthcare Conference in San Francisco, Acting CMS Administrator Andy Slavitt charged that repealing the ACA with only the promise to produce a replacement plan later is irresponsible.

“Millions of Americans and their families would be harmed by this scheme,” said Slavitt. “Not putting a replacement plan forward would create needless chaos for hospitals and insurance companies. They need to begin making decisions on their 2018 participation just a few months from now.”

On the topic of ACOs, Slavitt said that providers want to “experience the joy of medicine again” and “to be able to make a living from listening to their patients, coordinating their care, improving their health, and get paid for what works.”

“Whether you call these ACOs or Medical Homes or Bundled payments frankly doesn’t matter,” he concluded. “What matters is that we can develop these innovative practices locally, test them and spread them.”

Slavitt suggested that the CMS Innovation Center, which was created by the ACA to test innovative payment and service delivery models to reduce program expenditures while preserving and enhancing the quality of care, would also fall victim to repealing Obamacare.

“CMS has been the driver of innovation in value-based care—bar none. They’re way out ahead of the private sector in terms of innovative payment models,” comments Tripathi. “If you take that away and undercut those efforts, that will have a big impact on health IT because those organizations are using technology in ways that deliver value.”

He points out that alternative payment models such as ACOs are designed to improve quality and health outcomes, while reducing the cost of care, by unlocking the value of healthcare data and that these organizations rely on a strong HIT infrastructure and the ability to exchange data to achieve these goals.

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