 Image of P|PC Chairman Tony Coelho | It is hard to know where to begin in such a moment. In my lifetime, I have never seen anything like this riotous transition of power, with insurrection led by a power-hungry President and his delegates. While the world is watching insurrection, agencies under his control are pushing out rules and waivers that may not be easily undone. |
On January 8, 2021, the Centers for Medicare and Medicaid Services (CMS) approved the TennCare II Demonstration, a Medicaid waiver that converts the bulk of TennCare’s federal funding to a block grant. It is described as covering core medical services, while imposing a closed formulary on TennCare beneficiary drug coverage. When you get into the weeds of it, it’s fascinating to watch this administration speak from both sides of their mouths. Tennessee’s waiver application made it clear they would restrict their formulary using measures of cost effectiveness – which rely on discriminatory metrics called quality -adjusted life years or QALYs. Advocates, including the Partnership to Improve Patient Care – opposed the waiver application on the basis of its implications for discrimination against people with disabilities and chronic conditions whose lives are inherently devalued in these cost effectiveness analyses, thereby concluding treatments for them are not cost effective. CMS gave lip service to these comments, but it is not enough to have CMS point out anti-discrimination laws such as the Americans with Disabilities Act if the federal government is going to give states explicit authority in an approved waiver to do just that - discriminate.
So many of us hoped that the administration ran out of time on this. We knew early in the Trump administration that they had opened the door to use of cost effectiveness in CMS’ 2018 response to a rejected Massachusetts waiver, not to mention its efforts to import QALYs from foreign countries into Medicare through a policy called “Most Favored Nation.” Despite so much progress educating policymakers on the implications of incorporating the use of discriminatory metrics such as QALYs into health care, this administration has no moral or ethical compass driving its decisions. Republicans and Democrats alike have taken a stand against relying on the discriminatory metrics that underpin cost effectiveness analysis to determine who will or will not get care and treatment, starting with a Republican administration rejecting a state waiver relying on QALYs in 1992, to the clear position of the DNC Platform rejecting use of QALYs.
To make matters worse, recent news tells us that the Trump administration is not only approving the Tennessee state waiver that likely violates civil rights laws but is instituting new procedures that will make it more difficult for a future administration to revoke such waivers. They want to require that existing demonstrations, carried out by a waiver, continue for at least nine months before they can be changed. Imagine – in the middle of a pandemic – that we are just going to let states implement discrimination in their Medicaid programs. It is unthinkable and certainly not conducive to a smooth transition of power.
It is appalling that this administration could care less about the people it is intended to serve, and cares more about making the transition hard for the next administration. That’s all this is. Pettiness with deadly implications for real people that may lose access to care.
So many of us hoped that the administration ran out of time on this. We knew early in the Trump administration that they had opened the door to use of cost effectiveness in CMS’ 2018 response to a rejected Massachusetts waiver, not to mention its efforts to import QALYs from foreign countries into Medicare through a policy called “Most Favored Nation.” Despite so much progress educating policymakers on the implications of incorporating the use of discriminatory metrics such as QALYs into health care, this administration has no moral or ethical compass driving its decisions. Republicans and Democrats alike have taken a stand against relying on the discriminatory metrics that underpin cost effectiveness analysis to determine who will or will not get care and treatment, starting with a Republican administration rejecting a state waiver relying on QALYs in 1992, to the clear position of the DNC Platform rejecting use of QALYs.
To make matters worse, recent news tells us that the Trump administration is not only approving the Tennessee state waiver that likely violates civil rights laws but is instituting new procedures that will make it more difficult for a future administration to revoke such waivers. They want to require that existing demonstrations, carried out by a waiver, continue for at least nine months before they can be changed. Imagine – in the middle of a pandemic – that we are just going to let states implement discrimination in their Medicaid programs. It is unthinkable and certainly not conducive to a smooth transition of power.
It is appalling that this administration could care less about the people it is intended to serve, and cares more about making the transition hard for the next administration. That’s all this is. Pettiness with deadly implications for real people that may lose access to care.
