Former CMS Administrator, Health Care Pundits Prognosticate on Reform Changes in a Romney Administration

Should former Mass. Gov. Mitt Romney (R) win the presidency on Nov. 6, he will push for repeal and replacement of the Affordable Care Act, raise the Medicare eligibility age to 67, end Medicaid expansion and give states much more discretion in how they handle their existing Medicaid enrollees, former CMS Administrator Tom Scully predicted during a luncheon keynote speech on Oct. 4 at AIS’s Health Business Roundtable in Washington, D.C.

Scully, who led CMS from 2001 to 2004 under former President George W. Bush (R) and is now senior counsel at Alston & Bird, LLP, told attendees that although Romney will push for repeal, if he is short on votes in Congress, he likely will pursue other means to slow new spending for the law’s provisions, which could cause at least a five- or six-year delay in implementing key provisions and lead to more of a gradual phase-in. He added that Romney probably would limit government spending on health care below the 20% of the U.S. Gross Domestic Product (GDP) it is supposed to hit by 2021, according to a June 2012 report from CMS. In 2011, health care accounted for 17.9% of GDP.

He also said that the health care industry stands to benefit more if President Barack Obama (D) is re-elected. “If you are in the health care business, vote for Obama. [But] if you have a conscience, vote for Romney.”

A Romney administration also likely would lead to a friendlier CMS in terms of policies that impact Medicare Advantage plans, Part D prescription drug plans and what Scully termed other “risk ventures.” And, he added, under Romney, “Medicaid expansion is gone.”

Scully offered up some names of who might be HHS secretary under Romney. At the top of Scully’s list is Louisiana Gov. Bobby Jindal (R), who served as HHS’s assistant secretary for planning and evaluation from 2001 to 2003. Possibilities for CMS administrator, according to Scully, include former Harvard Pilgrim Health Care CEO and former Mass. Health and Human Services Sec. Charlie Baker, Jr. (R) and former CMS General Counsel Thomas Barker.

Scully also offered some predictions on the makeup of the House and Senate after the election. He speculated that the House will probably stay under control of the Republicans. However, with numerous Senate races still running neck-and-neck, he speculated that the Senate could end up with a 50-50 split, though the Democrats likely will eke out a 51-49 majority.

In a separate roundtable discussion at the conference on Oct. 5, Henry Aaron, a senior fellow in economic studies at the left-leaning Brookings Institution, said that if Romney ends up winning the presidency and the Republicans take over both houses of Congress, efforts to go after the health reform law will be strengthened and could be accomplished through the budget reconciliation process.

Tom Miller, a resident fellow at the conservative American Enterprise Institute, concurred, saying that with a Republican takeover of Congress and the White House, they “can debone and fillet the [Affordable Care Act] and leave some [extra] around for soup.”

However, even if Republicans gain a slight majority in the Senate, that is no guarantee that Romney would have the votes to repeal the reform law, according to Bob Laszewski, a former insurance executive and president of consulting firm Health Policy and Strategy Associates. He said that several moderate Republicans, such as Maine Sen. Olympia Snowe, have said that they want to fix the law, not replace it. Laszewski added that Republicans would need to muster 60 votes in order to delay implementation of the law.

Hear more insights from Scully, Aaron, Laszewski, Miller and other top experts on today’s biggest challenges and creative solutions for health care leaders. The on-demand recording of New Health Insurance Business Models for a Post-Reform World will provide tips and tactics to help your organization thrive in the tumultuous days ahead, even if you couldn’t make it to D.C. for the Roundtable event. Click here for more information.