Less than two months into the new Trump administration and under Republican leadership, and the country is definitely in a tizzy.
Center stage now is the sharp debate that continues over the Republican plan to repeal and replace the Affordable Care Act. With the GOP in charge of Congress and the White House, the final form of the legislation, now called the American Health Care Act, is still in flux.
House leadership hopes to have a final form of the legislation up for a vote next month, but that looks to be optimistic—the debate is likely to continue for weeks. In addition to inevitable entrenched Democratic opposition, the proposed law introduced this week is running into opposition from conservative and moderate Republicans. While political pressure may force maverick Republicans to get in line, widespread opposition to the AHCA has arisen from multiple healthcare professional groups and consumer organizations, most notably the American Association for Retired People.
The proposed law does not directly mention healthcare information technology, but I worry that it’s premature to believe that the law, as well as the ongoing transition to the Trump administration, won’t affect healthcare IT.
I see at least a couple potential ramifications for healthcare IT over the next few months.
For one, the political deliberations over AHCA are consuming significant bandwidth within Congress and the administration. And after the healthcare debate is resolved, other divisive issues will follow, such as tax reform. And the administration is embroiled in multiple time-consuming and attention-grabbing issues, such as implementing executive orders and defending itself against various charges.
And there’s only so much bandwidth to go around—congressional attention that’s sucked up by healthcare reform and other contentious issues can only take time away from other topics that are not nearly as exciting—such as healthcare IT.
As for the Trump administration, it’s lagging behind in making appointments to many crucial roles in various agencies and departments. One of those is the lead role for the Office of the National Coordinator for Health Information Technology. That’s probably not a high-priority role for the Trump administration to fill, but it does have a wide impact on the industry we all find ourselves in, and where the industry heads from here.
Jon White, MD, is leading ONC as the acting national coordinator, and from indications at a town hall event at HIMSS17, it’s attempting to make progress on key initiatives, such as the interoperability provisions of the 21st Century Cures Act. But only so much can be done—for example, White said that the law contains legislative language that give specific authority to ONC and separately to the HHS Secretary, as well as shared jurisdiction between the two entities, and sorting those out has been delayed. Those important details are just the kinds of things that are affected by a slow transition.
Secondly, there’s the money—specifically, the money required to fund programs that are important to HIT.
The Trump administration has made its statement on priorities—it wants to ramp up spending for defense, in a big way, seeking to increase military spending by $54 billion. That’s certain to come at the expense of spending by a host of other departments.
The impact on HIT here seems less clear. The ONC budget is miniscule compared to other components of the federal budget. However, other budget decisions could affect HIT indirectly.
For example, the latest version of the GOP healthcare bill would end the ACA’s Prevention and Public Health Fund, which provides about $1 billion a year to support public health, in 2019. That’s in addition to budget cuts for the Centers for Disease Control and Prevention that might cover increased defense spending.
It’s not clear how budget reductions for the CDC might impact its programs, particularly the 21st Century Cures Act and the Cancer Moonshot, which received $1.8 billion to make great strides against the disease. These initiatives are expected to advance genomic medicine and the IT needed to support them.
Both 21st Century Cures and the Cancer Moonshot received broad bipartisan support—at the time. However, extraordinary times and financial pressures could cause recalibration in financial priorities, and many things that seemed sacred only a few months ago (for example, funding protection of the environment) have been rapidly discarded under this new regime.
Big rollbacks may not happen, and federal leadership on HIT may move forward unhindered. However, we live in interesting times, and HIT executives need to pay attention, and exert pressure, to make sure that the valuable progress that’s been made doesn’t get buried under other priorities.
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