Slide 1 ©2015

Washington Policy Update & the ACA

24th Annual Symposium Missouri Group Management Association

October 3rd, 2017

Kansas City

Cora Butler, JD,RN,CHC

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Slide 2

THE CONTENT OF THIS PRESENTATION IS INTENDED FOR

EDUCATIONAL PURPOSES ONLY, NOT LEGAL ADVICE

OR THE INSIGHTS OF A CRYSTAL GAZER

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Slide 3 Learning Objectives

Discuss status of the Trump Administration and Republican Party leadership relative to healthcare policy changes as reflected in proposed or enacted legislation.

Discuss current posture of the Democratic Party relative to healthcare policy changes as reflected in proposed.

Identify key distinctions between the Affordable Care Act (ACA aka Obamacare) and the current proposed.

Describe the likely impact of the status of the proposed legislation on key stakeholders.

Recognize key strategies for future success regardless to changes in US healthcare policy and law.

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Slide 4

Why Repeal?

The Republican Rationale

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Slide 5 True Impact on employment: 2 million FTE will be out of work force by 2025- Congressional Budget Office

Increased health care premiums by 25% in 2017-

New York Times

True 19.2 million taxpayers chose to pay a penalty/seek exemption rather than enroll in ACA exchange- IRS

True Lack of options- ⅓ of US Counties have only 1 insurer- Time.com

True Individual Mandate- American taxpayers paid $3 billion for individual mandate penalties affecting 8 million people in 2016- Investor’s Business Daily

True ACA cost Americans over $1 trillion in taxes-Congressional Budget Office

Penalty for a family- Maximum $2085- Healthcare.gov

CLICK

HERE

Source: QUIZ: How has Obamacare failed? (n.d.). Retrieved April 11,

2017, from https://housegop.leadpages.co/obamacare-fails-quiz/

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Slide 6

Washington, What’s going on!

Glimpse of the Rollercoaster ride

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Slide 7

Jan 12, ‘17 Jan 20, ‘17Nov 9, ‘16

’

Donald Trump wins the election (304-227)

Senate voles allowing the repeal of the ACA through the budget reconciliation

process; disallows a filibuster

Noon: Trump takes the Presidential Oath of Office

2:00 pm: Trump signs the Executive Order

‘Minimizing the Economic Burden of the PPACA Pending Repeal’

Source: Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11, 2017, from

https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act

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Slide 8

Mar 23, ‘17 Mar 24, ‘17Mar 6, ‘17

Scheduled vote for the GOP bill, later postponed to March 24,2017

House Republicans publicly release ‘The American Health Care Act’

Introduced the ‘Phase One’ of the 3-phase plan to repeat ACA

The AHCA bill was withdrawn- failure to gain sufficient House Republican

support

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Slide 9

Apr 4, ‘17 Apr 6, ‘17Mar 28, ‘17

House Speaker Paul Ryan- “still moving

forward with health care” with no

scheduled timeline

House Speaker Paul Ryan-“Proposal under conceptual stages”

Republicans add a new amendment to the AHCA- ‘Federal Invisible Risk Sharing

Program’ adding $15 billion fund to help insurers pay claims for the sickest

customers

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Slide 10

Apr 24, ‘17Apr 7, ‘17

WHO (Donald Trump) picks up the healthcare policy ball

and throws it to WHAT (Paul Ryan).

WHAT throws it to I DON’T KNOW (House Republicans)

and

I DON”T KNOW (House Republicans) throws it to Spring

Recess

A bona fide triple play!

Post Spring Recess

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Slide 11 Jul 28, ’17 “Skinny Repeal” - Strikes Out with 49 to 51 votes

• Skinny Repeal/ Repeal/ Delay tactic

• Elimination of ACA Requirements– Individual mandate and tax penalty

– Employer-sponsored health insurance (=>50 employees)

– Funding for Preventative Health Services

– Reimbursement for Medicaid Beneficiaries for Planned Parenthood services – 1 year

• Plan Aimed– Steer funding to Community Health Centers

– End 2.3% Tax on medical device manufacturers – 3 years

– Empowered States to allocate Medicaid funding – pooling with other programs

– Increase the limit on contributions to tax-exempt HSAs – 3 years

• CBO stated: “Skinny repeal’ of Obamacare would leave 16 million more people uninsured in a decade”

• McCain cast the deciding vote based on his desire for a fully legislated bipartisan effort to repeal and replace the ACA

Source: The Washington Post. Senate rejects measure to partly repeal Affordable Care Act retrieved September 18,2017,

https://www.washingtonpost.com/powerpost/senate-gop-leaders-work-to-round-up-votes-for-modest-health-care-overhaul/2017/07/27/ac08fc40-72b7-11e7-8839-

ec48ec4cae25_story.html?tid=a_inl&utm_term=.455c251ef746

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Slide 12 Sep 5, ’17 “What’s Going on in the Outfield?”

• Senate Health, Education, Labor, and Pensions Committee Hearings– Goal: Passing a modest bill to help stabilize the Obamacare health insurance

markets for 2018

– Then move on to broad reforms to attract more insurance companies to compete in the individual markets and potentially lowering the prices for consumers

• Committee Chairman Lamar Alexander said– "State insurance commissioners have warned that abrupt cancellation of

cost-sharing subsidies would cause premiums, copays and deductibles to increase and more insurance companies to leave the markets in 2018"

– "Congress now should pass balanced, bipartisan, limited legislation in September that will fund cost-sharing payments for 2018“

• Federal government should make it easy for the states to get waivers to implement health policies that differ from Obamacare

• Insurance Companies have until Sep 27th to sign contracts offering health plans on ACA exchanges and the prices for next year

• President Trump has threatened to end the payments and has refused to even say whether the government will make them for the final four months of this year

Source: Chastened Lawmakers Aim For Small, Bipartisan Health Care Victories retrieved September 18, 2017, http://www.npr.org/sections/health-

shots/2017/09/05/548676514/chastened-lawmakers-aim-for-small-bipartisan-health-care-victories.

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Slide 13 Sep 13, ’17 “A New Pitcher Starts Warming Up for the Opposing Team”

• Bernie Sanders proposes a ‘New Single Payer Health Plan’

– Essentially its “Medicare for all”

– Every American would eventually get insurance from Medicare instead of private companies or other public programs

– Provision are tucked into Title X of the bill

– 4 year transition period from current policy to Sanders Medicare-for-all system

– During the transition – young folks may have to access the traditional Medicare program

– Provision creates an option for Americans to buy access to a Medicare-like government plan, which are to be sold on the Obamacare Exchanges

– Parts of the bill lead to a road map for what some of the strategies might look like

• Elimination of

– Employer health insurance system

– ACA Exchanges

– Most of Medicaid

Source: The New York Times. How the Bernie Sanders Plan Would Both Beef Up and Slim Down Medicare retrieved September 18, 2017,

https://www.nytimes.com/2017/09/13/upshot/how-the-bernie-sanders-plan-would-both-beef-up-and-slim-down-medicare.html

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Slide 14 Sep 13, ’17 “A New Pitcher Starts Warming Up for the Opposing Team”

Source: The New York Times. One-Third of Democratic Senators Support Bernie Sanders’s Single-Payer Plan

https://www.nytimes.com/interactive/2017/09/13/us/sanders-medicare-for-all-plan-support.html

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Slide 15 Sep 18, ’17 “Squeeze Play” - The Graham-Cassidy-Heller-Johnson Bill

• 17 days left to accomplish something

• Budget Reconciliation Process Senators Graham, Cassidy, Heller, and Johnson introduce bill

• Bill leaves policies of ACA in place

– Quality, Value, Compliance

• Focuses on the insurance components

– Shifting to block grants

– Insurance regulation up to the discretion of each State

• Bill puts a ban on insurer’s refusing to cover pre-existing conditions

• Larry Levitt, senior vice president of the Kaiser Family Foundation

– “Over time, it’s less federal money than is being spent now on health care, but it’s still a huge pot of money available to states with very few strings attached”

– “If this bill passed, it would get Congress off the hot seat of figuring out how to deal with health care — but unleash 50 debates in state capitals around the country”

Source: The Washington Post. GOP tries one more time to undo ACA with bill offering huge block grants to states retrieved September 18, 2017,

https://www.washingtonpost.com/powerpost/gop-bill-to-block-grant-major-parts-of-the-aca-unveiled/2017/09/13/bdcd1872-988b-11e7-87fc-

c3f7ee4035c9_story.html?tid=a_inl&utm_term=.f6d6a69ddf40

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Slide 16

Sep 18, ’17 Trump’s late-night tweet

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Slide 17 Sep 25, ’17 Graham-Cassidy Bill Hearing

• Senate Finance Committee’s hearing was on the updated version of the bill

• The changes to the bill were said to be “just correcting drafting errors” by Graham, who also suggested “it’s OK to vote. It’s OK to fall short, if you do, for an idea you believe in”

• Cassidy on the other hand suggested that lawmakers would not makes any changes to the bill

• The changes in the language of the bill left lawmakers and healthcare experts uncertain

• “No cuts to Medicaid. Save our liberty!” was chanted by the protesters during the hearing, which was adjourned to escort protesters out

• CBO’s preliminary score suggests– Medicaid spending would fall by about $1 trillion from 2017 to 2026, compared

with current law

– “Millions” would be left without comprehensive health coverage due to the ACA individual mandate and cuts to Medicaid funding and subsidies for private coverage

• Standard & Poor's Global Ratings suggests– Reduction in coverage levels, particularly for those between 133 percent and 400

percent of the federal poverty line

– The economy would face a $240 billion loss by 2027 and that 580,000 jobs could be affected

Source: The Advisory Board. GOP abandons planned vote on Graham-Cassidy. (2017, September 26). Retrieved from https://www.advisory.com/daily

briefing/2017/09/26/graham-Cassidy-projections?

WT.mc_id=Email%7CDailyBriefing%2BHeadline%7CDBA%7CDB%7C2017Sep26%7CATestDB2017Sep26%7C%7C%7C%7C&elq_cid=2407203&x_id=003C0000024R

VwpIAG

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Slide 18 Sep 26, ’17 The Vote on Graham-Cassidy Bill Abandoned

• A decision not to hold a vote on the revised bill to repeal

and replace large portions of the ACA and overhaul

Medicaid was made

• Most significant development – Sen. Collins joined with

Sen. John McCain in opposing the bill

• Collins said, “the both the versions of the bill will open

the door for states to weaken protections for people with

pre-existing conditions, such as asthma, cancer, heart

disease, arthritis, and diabetes”

• McCain appeared to be a hard “no” and disagrees with the

process being used to pass an ACA repeal bill

• September 30th – Hard ACA repeal deadline is past

Source: The Advisory Board. GOP abandons planned vote on Graham-Cassidy. (2017, September 26). Retrieved from https://www.advisory.com/daily

briefing/2017/09/26/graham-Cassidy-projections?

WT.mc_id=Email%7CDailyBriefing%2BHeadline%7CDBA%7CDB%7C2017Sep26%7CATestDB2017Sep26%7C%7C%7C%7C&elq_cid=2407203&x_id=003C0000024R

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Slide 19 Sep 27, ’17 ACA Repeal come back next month?

• The FY 2017 budget reconciliation process which would allow the GOP to pass the ACA repeal with a filibuster-proof majority, runs out on September 30th

• Senate Republicans variety of ways to keep the option of 50-vote ACA repeal after September 30th:

– Could later pass a new, revised budget resolution for FY2018

– Could pursue less sweeping (but still impactful) ACA changes that might not require reconciliation instructions for all four committees

– Could employ the so-called "nuclear option" and overrule the parliamentarian to forge ahead with 50-vote repeal

– Could include a provision in the FY2018 budget resolution "extending the 'life' of the current ACA repeal effort

• Bottom line, GOP still has an option of doing the health reform, tax reform or both after September 30th, just has to pass the FY2018 budget resolution which cannot be filibustered

Source: The Advisor Board. ACA repeal is dead for this month. Here's why it could come back next month or next year. (n.d.). Retrieved from

https://www.advisory.com/daily-briefing/2017/09/21/50-vote-

repeal?WT.mc_id=Email%7CDailyBriefing%2BHeadline%7CDBECPost%7CDBA%7CDB%7C2017Sep26%7CATestDB2017Sep26%7C%7C%7C%7C&elq_cid=2407

203&x_id=003C0000024RVwpIAG

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Slide 20 Sep 28, ’17 Unanimous Approval on a Health Bill

• The bill was initially introduced in April by the Senate Finance Committee’s Chronic Care Working Group, but failed to gain traction

• Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act wants to reduce costs and improve the Medicare payments for care

• The new bill implements Medicare payment policies– Expansion of Medicare Advantage plans

– Expansion of ACO coverage

– Provision for telehealth services – home dialysis and stroke assessments

– Extend by two years the demonstration period for CMS' Independence at Home program

– Increase the number of allowable Medicare beneficiaries in the program from 10,000 to 15,000

– Permanently extend the MA Special Needs program for beneficiaries who are chronically ill

– Medicare reimbursements for additional non-health and social services, such as meal deliveries and transportation to doctors' appointments

• CBO projected that this bill would– Generate $80 million in savings

– And help offset the measure’s cost

• Bill heads to the House, where its unlikely to be pass

• Several provisions of the bill have been proposed– HR 3727, which would expand telemedicine under MA

– HR 1148, which includes the CHRONIC Care Act's tele-stroke provisions

– HR 3178, which includes the CHRONIC Care Act's kidney dialysis provisions

• Senate Finance Committee Chair Orrin Hatch (R-Utah) in a statement said, "This legislation will improve disease management, lower Medicare costs and streamline care coordination services—all without adding to the deficit

• Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) on the day of the bill's passage said, "Today is a big day in the ongoing effort to update and strengthen Medicare's guarantee to seniors

Source: The Advisory Board. The Senate unanimously approved a health bill yesterday. (No, not that health bill.). (2017, September 28). Retrieved from

https://www.advisory.com/daily-briefing/2017/09/28/chronic-care-

act?WT.mc_id=Email%7CDailyBriefing%2BHeadline%7CDBA%7CDB%7C2017Sep28%7CFinalDB2017Sep28%7C%7C%7C%7C&elq_cid=2407203&x_id=003C000

0024RVwpIAG

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Slide 21

#RepealAndReplace

The American Health Care Act

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Slide 22

AIM

S Dismantle the Obamacare taxes

Eliminate the individual and employer mandate penalties

Prohibit health insurers from denying coverage/charging more money

Help young adults access health insurance and stabilize market place-allow coverage until age 26

Modernize and strengthen Medicaid- Transition to ‘per capita allotment’

Establish a Patient and State Stability Fund- provide states with $100 billion to design programs that meet their unique population

Empower individuals and families-enhance and expand Health Savings Accounts

Help access affordable, quality health care- providing a monthly tax credit between $2000 and $14,000

AP

PR

OA

CH

Step I- RECONCILIATION

The American Health Care Act: Introduction of the Bill, Consideration by the House, Pass legislation through regular order

Step II- ADMINISTRATIVE ACTION

HHS Secretary ????? may deregulate the marketplace to stabilize it, increase choices and lower costs

Step III- ADDITIONAL LEGISLATION

Pass conservative-minded bills to allow shopping across state lines, medical liability reform, and more.

Source: Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/healthcare/#top

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Slide 23

ACA vs Proposed Bills

Differences & Similarities

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Slide 24 ACA “Medicare for All” Paul-Stanford Bill

Insurance Mandates Individual mandate

Employer mandate on larger companies

No Individual or Employer

Mandate

No Individual or Employer

Mandate. Paul advocates

Associations/Cooperatives

offering group health

options across state lines.

Financial Supports

(subsidies) for

insurance consumers

Income-based subsidies for premiums that

limit after-subsidy cost to a percent of

income. Tax credits for out-of-pocket

expenses

Not applicable No subsidies, but more

affordable benefit plan

options.

Medicaid Matching federal funds to states for anyone

who qualifies Expanded eligibility to 138% of

poverty level income

Medicaid expansion not

applicable

Paul supports the idea of

state-by-state Medicaid

waivers

Health Savings

Accounts

Individuals can put $3,400 and families can

put $6,750 into a tax-free health savings

account

HSAs not applicable Expand HSAs

Essential Health

Benefits

Insurers are required to offer ten essential

health benefits

There would be a essential

health benefits package similar

to what Medicare offers, for all

Eliminated minimum

standards to leave more

flexibility around benefit

plan design for affordability

Pre- existing

conditions

Insurers are banned from denying coverage

for pre-existing conditions

Not applicable Protects them if they have

continuous coverage for 2

years

Dependents staying

on plan

Dependents can stay on health insurance plan

until age 26

Not applicable

Risk sharing Federal risk sharing program

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Slide 25

Remarks: Republican Leaders

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Slide 26

Remarks: Democratic Leaders

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Slide 27

Reactions: Primary Care Physicians

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Slide 28

• Raju Patnam MD, Family Medicine, Greenville SC

“ It is not addressing tort reform, cost of medications or payments to PCPs”

• Vikki Stefans MD, Pediatrics, Little Rock AK

“We need to go single payer or we need the individual mandate that would have made the ACA easily able to stand on its own two feet without skyrocketing premiums from some people.”

• Scott Helmers, MD, Family Medicine, Spirit Lake IA

“Trump-Ryan care is quite a step backward… If there is any value to Trump-Ryan care it will be that in its crashing we may see the country move to single payer, national healthcare.”

• Jeffrey Kagan, MD, Internal Medicine, Newington CT

“ Providers who took in many Medicaid patients under the ACA will be left with deciding to continue caring at a big discount or dumping them and then having many empty patient slots.”

• Sue Osborne, DO, Family Medicine, Floyd VA

“This is my simple request: whatever the reconstructionist design, they have the same healthcare policy options, and pay the same premiums as the rest of us, with no exceptions for the wealthy or the elected.”

Source: Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from

http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react-ahca?page=0%2C9

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Slide 29

Road Ahead

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Slide 30

What seems certain?

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Slide 31 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Strong bipartisan support

Delay would be tied to budgetary implications

Bending the Medicare cost curve is not a partisan issue

Move from FFS to value- based care

April 10, 2017

“I believe all options should be on the table to

ensure MACRA is implemented in a way that

benefits patients and keeps providers—

particularly those in small practices—in the

Medicare program.” US Rep. Phil Roe, MD, (R-Tennessee)

Source: Your questions about the MACRA final rule–answered. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/physician-practice-

roundtable/members/expert-insights/2016/nine-faqs-on-provider-payment-under-macra

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Slide 32 MACRA: Tracks & Scores

Source: Medisolv, Inc. Follow. (2016, September 16). The Basics of MACRA and 2017 Reporting Options [SLIDESHOW]. Retrieved April 11, 2017, from

https://www.slideshare.net/MedisolvMarketing/the-basics-of-macra-and-2017-reporting-options-slideshow

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Slide 33

Performance: The first performance period opens January 1, 2017 and closes December 31, 2017. During 2017, record quality data and how you used technology to support your practice.

Send in performance data: To potentially earn a positive payment adjustment under MIPS, send in data about the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018. In order to earn the 5% incentive payment by significantly participating in an Advanced APM, just send quality data through your Advanced APM.

Feedback: Medicare gives you feedback about your performance after you send your data.

Payment: You may earn a positive MIPS payment adjustment for 2019 if you submit 2017 data by March 31, 2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019.

MACRA: Reporting Timeline

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Slide 34 MACRA: Payment Adjustments

Source: E. (2016, May 18). How MIPS, APMs Work Under MACRA to Improve Value-Based Care. Retrieved April 20, 2017, from

https://ehrintelligence.com/news/how-mips-apms-work-under-macra-to-improve-value-based-care

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Slide 35

Anytime between January 1 and October 2, 2017. Whenever you choose to start, you'll need to send in your performance data by March 31, 2018. You can also begin participating in an Advanced APM.

The first payment adjustments based on performance go into effect on January 1, 2019.

Not participating in the Quality Payment Program: If you don’t send in any 2017 data, then you receive a negative 4% payment adjustment in 2019.

On choosing the MIPS path, you have three options.

• Test: If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment.

• Partial: If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment.

• Full: If you submit a full year of 2017 data to Medicare, you may earn a positive payment adjustment.

MACRA: When to start? Expected outcomes?

Source: MACRA. (n.d.). Retrieved April 20, 2017, from https://www.thenationalcouncil.org/macra/

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Slide 36

Key StrategiesHow can I succeed, no matter what changes!

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Slide 37

Reduce cost structure

Establish sustainable

Medicare risk strategy

Establish a consumer

loyalty platform

Elevate Physician network

performance

Adapt to New Market Realities

Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-

advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook

NOTE:

The success of these four elements depend heavily on an appropriate and scalable Health

IT platform

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Slide 38

Raw Data

• Clinical systems

• Billing/Claims

• Patient generated (e.g., wearables, portals)

• External data (e.g. social, financial)

BI Capabilities

• Data acquisition, aggregation

• Coherent architecture

• Governance

• Tools, staff skills

• Culture, organizational data literacy

Goal Optimization

• Clinical outcomes

• Patient experience

• Referral performance

• Financial efficiency

• Regulatory metrics

• Market share

Cut down administrative costs

Clinical Decision Support

(Evidence based)

Better Care Coordination

Improved patient wellnessEliminate Fraud and Abuse

Risk

Performance based referrals

Your data is your best friend!

Source: Top Ten Health IT Challenges for 2017. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-it-

advisor/events/webconferences/2017/top-ten-health-it-challenges-for-2017/ondemand

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Slide 39

NorthShore University Health System

Who

Identify patients at risk for hypertension and control risk of health attack and stroke

Why

Through a BI tool which:

How

• Linked practicing physicians with research and quality improvement- eliminate undiagnosed/at risk hypertension patients

• Flagged patients for additional follow up through algorithms

Identified, tested and diagnosed more than 500 patients with previously undiagnosed hypertension

Results

Success Story: Business Intelligence

Source: The Impact of Business Intelligence on Healthcare Delivery in the USA. (n.d.). Retrieved October 10, 2016.

http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf

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Slide 40

Define goals for yourself and your practice

Collect performance standards relevant to the goals

Perform a gap analysis between the existing performance with the goals/ benchmark with competitors

Use basic lean six sigma principles, root cause analysis, and other similar methods to identify and reduce variation

Establish a continuous quality assurance and performance improvement program to foster high quality in all areas of care and services

Quality Assurance & Performance Improvement

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Slide 41 Sample PI Tool: Readmissions Performance Tracking

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Slide 42

Washington University Physicians at Barnes

Who

‘Percutaneous Intervention’- Improving outcomes

What

Tailoring the following to patient needs:

How

• Equipment

• Access- Brachial vs Femoral

• Dosage of Contrast Media

• Anti-coagulant type- Bivalrudin vs Heparin ($547 vs <$1.22-2009)

Impact seen on:

Results

• Patient Safety & Outcomes

• Costs

• Readmissions

Success Story: Performance Improvement

Source: Sheikh IR, Ahmed S, Mori N, et al. Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral

Intervention: A Single-Center Experience. J Am Coll Cardiol Intv.2009;2(9):871-876. doi:10.1016/j.jcin.2009.06.015.

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Slide 43

Do not wait for the legislative changes

Focus of your strategy should be on accessibility,

affordability and reliability

Value based payment is here to stay!

Plan NOW to win tomorrow

Key Takeaways

Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-

advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook

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Slide 44 • QUIZ: How has Obamacare failed? (n.d.). Retrieved April 11, 2017, from

https://housegop.leadpages.co/obamacare-fails-quiz

• Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11,

2017, from

https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act

• Bryan, B. (2017, March 29). House Republicans might take another swing at repealing Obamacare.

Retrieved April 11, 2017, from http://www.businessinsider.com/ahca-trumpcare-obamacare-replacement-

bill-2017-3

• Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from

https://housegop.leadpages.co/healthcare/#top

• American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from

https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017

• American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from

https://www.cbo.gov/publication/52486

• Dinan, S. (2017, March 09). Ryan works to save GOP’s Obamacare repeal. Retrieved April 11, 2017,

from http://www.washingtontimes.com/news/2017/mar/9/paul-ryan-works-save-gops-obamacare-repeal/

• Geraghty, J. (2017, March 17). Tom Price: The Benchmark for Success Is Care, Not Coverage. Retrieved

April 11, 2017, from http://www.nationalreview.com/corner/445880/hhs-secretary-tom-price-benchmark-

success-care-not-coverage

• Remarks by President Trump and Administrator Seema Verma in Women in Healthcare Panel Meeting.

(2017, March 22). Retrieved April 11, 2017, from https://www.whitehouse.gov/the-press-

office/2017/03/22/remarks-president-trump-and-administrator-seema-verma-women-healthcare

References

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Slide 45 • DeBonis, M. (2017, March 27). Paul Ryan: House Republicans will continue their push for health-care

reform this year. Retrieved April 11, 2017, from https://www.washingtonpost.com/powerpost/paul-ryan-

house-republicans-will-continue-their-push-for-health-care-reform-this-year/2017/03/27/8e331e86-130c-

11e7-833c-503e1f6394c9_story.html?utm_term=.8af16aabf415

• Weigel, D. (2017, March 14). Sanders and Manchin, at opposite ends of Senate caucus, call ACA

replacement ‘immoral’. Retrieved April 11, 2017, from

https://www.washingtonpost.com/news/powerpost/wp/2017/03/14/sanders-and-manchin-at-opposite-

ends-of-senate-caucus-call-aca-replacement-immoral/?utm_term=.6bf6824b0c32

• Account, N. P. (2017, March 06). The GOP plan to #MakeAmericaSickAgain will do massive damage to

millions. https://t.co/r14nQmKHlI https://t.co/dQGtP9xcSK. Retrieved April 11, 2017, from

https://twitter.com/NancyPelosi/status/838915022176849921/photo/1

• Carney, J. (2017, February 27). Schumer blasts leaked GOP ObamaCare repeal bill. Retrieved April 11,

2017, from http://thehill.com/blogs/floor-action/senate/321344-schumer-blasts-leaked-gop-obamacare-

repeal-bill

• Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from

http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react-

ahca?page=0%2C9

• Hansler, J. (n.d.). Democrats react to collapse of GOP health care bill: 'So much for "The Art of the Deal"'

Retrieved April 11, 2017, from http://abcnews.go.com/Politics/democrats-react-collapse-gop-health-care-

bill-art/story?id=46361649

• Lima, C., Pollack, H., Glasser, S. B., & Grunwald, M. (n.d.). Sanders: Public outcry helped derail GOP

health care bill. Retrieved April 11, 2017, from http://www.politico.com/story/2017/03/bernie-sanders-

obamacare-public-outcry-236493

References

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Slide 46