Law Offices of George W. Bodenger, LLC

09/15/2021

DHHS Releases $25.5 Billion in COVID-19 Relief Funding
Targeting Smaller Providers

On September 10, 2021, the Biden-Harris Administration announced that the U.S. Department of Health and Human Services (“DHHS”), through the Health Resources and Services Administration, is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This represents the first additional funding availed for these purposes in nearly 12 months. The new funding comes roughly a week after Republican Senate leaders wrote to the Biden administration calling for the swift distribution of the remaining money. The funding is intended to bolster reimbursement to providers that serve a disproportionate amount of Medicare and Medicaid patients. The September 10, 2021 announcement comes as some provider groups have advocated for DHHS to release the remainder of the $178 billion relief fund passed by Congress in 2020. The funding includes $8.5 billion in resources from the American Rescue Plan Act passed earlier this year and another $17 billion from the Provider Relief Fund (“PRF”) previously established under the CARES Act.

The new funding will be allocated based on providers’ lost revenue and higher expenses from July 1, 2020 to March 31, 2021 (the “Reporting Time Period”). DHHS is specifically targeting smaller providers for lost revenues and COVID-19 expenses incurred at a higher rate, as compared to larger providers. There will also be bonus payments for providers that serve Medicaid, Children’s Health Insurance Program and/or Medicare patients. These bonuses will be based on the generally higher Medicare rates to ensure equity for those serving low-income children, pregnant women, people with disabilities and seniors. DHHS will also make payments to rural providers based on the amount of Medicaid, CHIP and Medicare services provided to patients in rural areas.

In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. DHHS will use existing Medicaid, CHIP and Medicare claims data in calculating payments. The application portal will open on September 29, 2021. To help ensure that these funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with, or acquisition of, another health care provider during the period in which they can use the payments. Providers who report a merger or acquisition may be more likely to be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy. Additionally, in light of the challenges providers across the U.S. are facing due to recent natural disasters and the Delta variant, DHHS has announced a 60-day grace period to help providers come into compliance with their PRF reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS has committed to not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.

For more information about eligibility requirements, the documents and information providers will need to complete their application, and the application process for PRF Phase 4 and ARP Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.
---------------------------------------------------------------------

Law Offices of George W. Bodenger, LLC, a boutique law firm specializing in healthcare law, is asked by a broad array of clients to provide innovative solutions to today's legal and business challenges. For more information, please visit www.bodengerlaw.com.

Law Offices of George W. Bodenger, LLC is a boutique legal practice providing legal services to various types of healthcare providers With over 20 years of experience, we have represented organizations in virtually every sector of the healthcare industry in a wide range of healthcare regulatory and....

07/20/2021

2022 MEDICARE PHYSICIAN FEE SCHEDULE PROPOSED RULE ISSUED ON JULY 13, 2021

BACKGROUND

On July 13, 2021, the Centers for Medicare & Medicaid Services (“CMS”) released the calendar year 2022 Medicare Physician Fee Schedule proposed rule (the “Proposed Rule”). The Proposed Rule describes CMS’ plans to revise Medicare payment policies and rates for the upcoming year. In the Proposed Rule, CMS sets forth its proposed changes in the regulations which codify its long-standing guidance on billing for “split (or shared)” evaluation and management (“E/M”) visits. Split (or shared) visits are E/M visits provided in part by both physicians and non-physician practitioners (“NPPs”). NPPs generally include nurse practitioners, physician assistants and advanced practice practitioners.

As a general matter, Medicare reimburses physicians at a higher payment rate than NPPs for various services. In the physician office setting, when a patient visit is performed in part by a physician and a NPP, the physician is permitted to bill for the visit, provided the visit meets the Medicare requirements for services furnished “incident to” a physician’s professional services. Historically, CMS relied on guidance found in the Medicare Claims Processing Manual (“MCPM”) to permit a physician to bill for visits performed in part by a NPP outside of the physician office setting. In May 2021, in response to a petition submitted under the U.S. Department of Health and Human Services Good Guidance Practices Regulation, CMS formally withdrew the MCPM sections specifically addressing split (or shared) visits and indicated that CMS would reissue the guidance as proposed regulations.

The Proposed Rule specifies the requirements that must be met in order for a physician or NPP to bill a split (or shared) visit in a hospital, skilled nursing facility (“SNF”) or other facility setting. If passed, the Proposed Rule will expand the clinical scenarios under which a healthcare professional can bill for services performed in part by another practitioner and would also impose restrictions on which performing practitioners can bill for the split (or shared) visit.

ANALYSIS AND DISCUSSION

In addition to clarifying when split (or shared) visits may be billed to Medicare, the Proposed Rule modifies CMS policy, permitting physicians and NPPs to bill for split (or shared) visits for both new and established patients, critical care services and certain E/M visits in a SNF. The prior guidance limited split (or shared) visit billing to established patients and prohibited billing for split (or shared) visits involving critical care services or in SNFs. The Proposed Rule defines “split (or shared) visit” as E/M visits performed in part by a physician and NPP in institutional settings for which “incident to” payment is not available. This is intended to distinguish between the policy applicable to services furnished “incident to” the professional services of a physician in a physician office setting and the policy applicable to services furnished in a facility setting on a split (or shared) basis.

Additionally, CMS is proposing to establish which of the physician or NPP performing a split (or shared) visit can bill Medicare for the visit. This is a very important concept because the visit is paid at a higher rate if the physician submits the claim rather than the NPP. Historically, in determining whether a physician or an NPP may bill for a split (or shared) visit, either the physician or NPP could bill for the service so long as the billing provider performed a “substantive portion” of the visit. In the Proposed Rule, CMS seeks to codify this policy by using time—as opposed to medical decision-making or a key component of the E/M visit—as the key factor in determining whether the physician or the NPP performed the substantive portion of the visit. The Proposed Rule would further limit the billing provider to the individual who performed more than 50% of the visit. In addition, CMS is proposing a list of activities that may count toward the total time of the E/M visit for purposes of determining the provider who performed the substantive portion of the visit. Under the Proposed Rule, documentation in the medical record will need to identify both professionals who performed the visit and the individual who performed the substantive portion (and bills for the visit) would need to sign and date the medical record.

Previous MCPM guidance generally prohibited the billing of split (or shared) visits for new patients. In the Proposed Rule, CMS is proposing important clarifications to its policy to permit either a physician or a NPP to bill for split (or shared) visits for both new and established patients and for initial or subsequent visits. This change expands the availability of split (or shared) visit billing in the facility setting. Under the previous MCPM guidance, CMS did not permit healthcare professionals to bill for split (or shared) visits for critical care services or for E/M visits furnished in a SNF. In the Proposed Rule, CMS is proposing to permit healthcare providers to bill for split (or shared visits) that are critical care services. The Proposed Rule also states that no other E/M visit can be billed for a patient on the same date as critical care services are furnished when the services are furnished by the same professional (or professionals) in the same specialty and group. The Proposed Rule also expands split (or shared) visit billing to permit E/M visits to be furnished by a physician and a NPP in a SNF setting.

In the Proposed Rule, CMS explicitly declined to define “same group” for purposes of the new split (or shared) visit billing rule and is seeking comments on how to define same group. While the Proposed Rule retains the requirement that split (or shared) visits be performed by a physician and NPP who are in the same group, CMS noted that it considered several options, including using the “group practice” definition under the Stark Law or considering practitioners under the same billing tax ID number to be the same group practice. CMS also noted that some of the options it evaluated do not align with the definition of “group” used for Medicare enrollment purposes. This determination is of significant import because if the two practitioners are determined not to be in the same group, neither of them may be able to bill for the visit if neither performed a complete E/M visit. CMS, under the Proposed Rule, will not pay for partial E/M visits.

Finally, the Proposed Rule seeks to create a claim modifier that would be mandatory for split (or shared) visits. This modifier would allow CMS to identify services furnished in part by NPPs and allow for more targeted review of services furnished by physicians and NPPs.

In summary, the Proposed Rule provides both new opportunities for billing split (or shared) visits, but also restricts the reimbursement opportunity for services that are performed primarily by NPPs. Providers have an opportunity to provide comments to the Proposed Rule, which must be submitted by September 13, 2021.

______________________________________________________________

Law Offices of George W. Bodenger, LLC is a boutique legal practice providing sophisticated legal services to a broad range of healthcare providers. Please contact George W. Bodenger at 610-212-5031 or [email protected] if you have any questions regarding these matters or if you would like additional information about the Firm.

12/11/2020

CMS Finalizes Overhaul To Stark And Anti-Kickback Laws

On November 20, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released the final rules amending two (2) of the primary bodies of federal law governing commercial conduct in the healthcare industry, the physician self-referral prohibitions (known as the “Stark Law”) and the Anti-Kickback Statute (“AKS”). The Stark Law and AKS were initially created for a fee-for-service healthcare system, where there are financial incentives to provide more services to patients. Efforts to clarify these outdated laws began in 2018, with the goal of accommodating changing financial arrangements triggered by the shift from fee-for-service to value-based care in the U.S. healthcare system.

The Stark Law, was initially enacted to prohibit physicians from making referrals to entities with which they had a financial relationship (i.e., ownership interest, compensation arrangement). The final rule creates exceptions for specific value-based payment arrangements among and between various providers and suppliers, and offers new guidance for providers with a financial relationship governed by the Stark Law. Under the rule, a value-based arrangement is one that provides at least one (1) value-based activity to a patient between the value-based enterprise and at least one of its participants, or the participants in the same value-based enterprise. A value-based activity can mean the provision of a service, an action, or refraining from taking an action, so long as the activity reasonably related to the achievement of a value-based purpose.

The final rule creates three (3) new exceptions to the Stark Law:

1. Value-based arrangements for participants in a value-based enterprise that is financially responsible for, and assumes the entire prospective financial risk, for the cost of all related patient care items and services for every patient;
2. Value-based arrangement remuneration to physicians at meaningful downside financial risk of failing to reach the value-based purpose of the enterprise; and
3. Value-based compensation arrangements, no matter the risk undertaken by the enterprise or participants. This exception also allows for monetary and nonmonetary remuneration among the parties.

The AKS is a criminal statute, focused on the intent of the provider, that prohibits intentional remuneration, in cash or in kind, in exchange for referrals of items and services reimbursable by a Federal healthcare program. This final rule adds new safe harbors to protect specific payment practices and business arrangements from AKS penalties to allow for improved coordination and patient care management and value-based care. Under the final rule, three (3) new AKS safe harbors are created:

1. Care coordination arrangements that enhance quality, health outcomes, and efficiency, without necessitating that the participants assume risk. Protected remuneration under this safe harbor must be mainly used to engage in value-based activities directly associated with coordination and management of patient care;
2. Value based arrangements involving the exchange of remuneration among a value-based entity that has substantial downside financial risk from a payor and a value-based participant that meaningfully shares in this financial risk; and
3. The protection of remuneration between value-based entity and value-based participant in a value-based arrangement in which the entity assumes full financial risk for the cost of items and services covered by the payor for each patient.

These new Stark Law exceptions and AKS safe harbors are receiving mixed reviews from healthcare providers. Hospital industry groups such as the American Hospital Association and the Federation of American Hospitals were optimistic about the regulatory changes, while physician groups such as the American Medical Group Association expressed some degree of skepticism.

____________________________________________

Law Offices of George W. Bodenger, LLC is a boutique legal practice providing sophisticated legal services to various types of healthcare providers. The Firm plans to issue additional commentary on these important changes to the Stark Law and the AKS. Please contact George W. Bodenger at 610-212-5031 or [email protected] if you have any questions regarding these matters or if you would like additional information about the Firm.

10/27/2020

Providers Must Apply by November 6, 2020 for a
Share of $20 Billion CARES Act Distribution

On October 1, 2020, HHS announced it would be allocating an additional $20 billion as its Phase 3 General Distribution from the Provider Relief Fund (“PRF”) through the CARES Act. This Phase 3 General Distribution is intended for providers who were either excluded from the initial two (2) phases, or who were eligible under the first two (2) phases but require additional funding to cover ongoing financial losses incurred during the pandemic. Time is running out for health care providers to apply to HHS for these funds. The application deadline for what may be the final round of relief funds is November 6 at 11:59 pm EST. HHS urges providers to apply as soon as practicable. The applications are accepted on a rolling basis, so HHS asks that providers not apply during the final days of the application period.

The following paragraphs highlight key information regarding the Phase 3 General Distribution:

Who Can Apply?

The following providers are eligible for Phase 3 General Distribution funding: (1) providers who have previously received, rejected or accepted a General Distribution PRF payment; (2) behavioral health providers, including those that have previously received funding; and (3) healthcare providers that began providing services from January 1, 2020 through March 31, 2020.
On October 22, 2020, HHS announced that additional providers, such as residential treatment facilities, chiropractors, and eye and vision providers that have not yet received PRF distributions, are also eligible to receive funds from this last distribution.

When Will Distributions Be Made?

HHS will issue Phase 3 – General Distribution payments as soon as practicable after the November 6th application deadline. Entities that have not yet received two percent (2.0%) of annual revenue from patient care will be first to receive funds from the Phase 3 General Distribution.

The Phase 3 final payment amounts for applicants that have already received payments equaling two percent (2.0%) of annual patient care revenue will be determined once all applications have been received and reviewed.

How Will HHS Calculate 2% of Annual Revenue for Providers in Operation Less Than a Year?

Providers that began providing patient care in 2020 will be paid approximately 2% of patient care revenue based on the applicant's reported financial information for those months in 2020 that they were in operation.

HHS has also stated that it may consider data from the same type of provider as the applicant when assessing the amount to be paid. However, no additional details have been provided regarding how that assessment of similar providers will be utilized to assess funds to be received.

How Will Distributions Over 2% of Annual Revenue Be Calculated?

The Phase 3 General Distribution will also take into account the financial impact of COVID-19 on individual providers and assess whether additional funds should be distributed to certain providers. The actual additional amount to be received will depend in part on the CARES Act funds available after the Phase 3 General Distribution to those that have not yet received an amount equivalent to 2% of annual revenue.

In assessing whether to award a provider additional funds over the two percent (2.0%) annual revenue amount, HHS will consider: (1) a provider’s change in operating revenue from patient care; (2) a provider’s change in operating expenses from patient care, including coronavirus expenses, and (3) payments received by the provider as part of previous Targeted Distributions.

Providers are encouraged to start the application process as soon as possible so as to not miss out on what may be the last general distribution of funds.

--------------------------------------------------------------------------

If you or your healthcare organization has any questions pertaining to Provider Relief Fund reporting, audits, or healthcare compliance, please contact George W. Bodenger at 610-212-5031 or [email protected].

10/13/2020

Provider Relief Fund Introduces Phase 3 General Distribution

Around the time of the start of the coronavirus (“COVID-19”) pandemic, Congress established the Provider Relief Fund (“PRF”) through the CARES Act in order to help providers who were financially damaged by COVID-19. Through October 1, 2020, there were two (2) phases for general funding, and multiple targeted allocations. The Phase 1 General Distribution allocated $30 billion to eligible providers, and the Phase 2 General Distribution allocated $20 billion to eligible providers, to be distributed by the U.S. Department of Health and Human Services (“HHS”). In addition to the general distributions, HHS also provided several targeted allocations, including to areas which were hit especially hard by COVID-19, including rural healthcare providers and skilled nursing facilities.

On October 1, 2020, HHS announced it would be allocating an additional $20 billion as its Phase 3 General Distribution. This Phase 3 General Distribution is intended for providers who were either excluded from the initial two (2) phases, or who were eligible under the first two (2) phases but require additional funding to cover ongoing financial losses incurred during the pandemic. The application period for this funding began on October 5, 2020 and will end on November 6, 2020. HHS urges providers to apply as soon as practicable. The applications are accepted on a rolling basis, so HHS asks that providers not apply during the final days of the application period.

The following providers are eligible for Phase 3 General Distribution funding: (1) providers who have previously received, rejected or accepted a General Distribution PRF payment; (2) behavioral health providers, including those that have previously received funding; and (3) healthcare providers that began providing services from January 1, 2020 through March 31, 2020. All providers who receive payments must attest to receiving the payment and accept the associated terms and conditions.

HHS will be using the following criteria in making payment determinations: (1) whether the provider has previously received a PRF payment equal to two percent (2.0%) of patient services revenue; (2) any change in operating revenues from patient care services; (3) any change in operating expenses from patient care services; and (4) any payment already received through prior PRF distributions that represented less than two percent (2.0%) of patient services revenue.

Behavioral health providers are a particular focus of this Phase 3 General Distribution. Although some were eligible for earlier general distributions, HHS has made it a point to include all behavioral health providers as eligible in this Phase 3 General Distribution. As the COVID-19 pandemic has progressed, the prevalence of symptoms of anxiety in the U.S. has increased from 8.1% in 2019 to 25.5% in 2020, and the prevalence of symptoms of depressive disorder grew from 6.5% in 2019 to 24.3% in 2020. As a result, many behavioral health providers had to adopt new telehealth technologies to provide patient care—which required a significant amount of funding. This distribution is intended to assist with these increased costs and increased utilization of behavioral health services.

---------------------------------------------------------------------------------------------

If you or your healthcare organization has any questions pertaining to Provider Relief Fund reporting, audits, or healthcare compliance, please contact George W. Bodenger at 610-212-5031 or [email protected].

02/23/2017

As health systems develop and implement strategies around clinical care redesign and health care reform, industry participants often ask how clinically integrated networks (“CINs”) relate and compare to accountable care organizations (“ACOs”). While unquestionably linked, each of these concepts has its own unique definition and purpose. The following paragraghs present summary comparisons of key operating features and characteristics of CINs and ACOs.

DEFINITION

CIN - A network of independent medical practices and physicians who collectively commit to quality and cost improvement. Physicians in the CIN may collectively negotiate third party payer contracts under a “safe harbor” from federal antitrust law relating to joint contracting being "reasonably necessary" to support investment (of both time and resources) in performance improvement and ensure cross-referrals among participating providers.

ACO - A group of different provider types across the care delivery spectrum – potentially including medical practices, physicians, hospitals/health systems and other non-acute care facilities – that are compensated based on their collective responsibility for the total cost and quality of care provided to a given patient population over a defined time period.

CARE MANAGEMENT FOCUS

CIN - Focus of care management and care improvement for medical practices/physicians across specialties; often a foundational element toward the formation of an ACO.

ACO - Focus on care management and improvement for an entire patient population, across the continuum of care delivery for that population. Physician integration is an integral part of any ACO.

COST TO PHYSICIANS

CIN - Free, non-risk bearing contracts that provide networks with the option to negotiate an ACO contract with a local payer with risk for the local population if it so chooses.

ACO - Variable and dependent on the ACO contract terms. An ACO is taking on a contract and can be set up in different ways. Some ACOs have no downside risk to providers whereas other providers could be asked to participate in risk.

PERFORMANCE INFRASTRUCTURE INVESTMENT

CIN - Significant capital requirements from an individual physician perspective ((e.g., $10,000 per physician in start-up costs, $2,500 in annual operating costs).

ACO - Typically require significant investments in reporting and care management infrastructure. Estimates for viable ACO start-ups range from $11.6 million to $26.1 million, depending on the size of the sponsoring health system (Source: American Hospital Association).

EXCLUSIVITY

CIN - In early stages of development, there is little or no opportunity to require participating physicians to contract exclusively through the CIN.

ACO - Structured with varying degrees of exclusivity from a contracting standpoint, depending on the market power of the sponsoring health system and the overall competitive environment.

FINANCIAL RISK

CIN - There is usually only an “upside” based on achievement of performance incentives in CIN arrangements. More evolved CINs often participate in contracts through an ACO, which gives rise to the ability to assume greater levels of financial risk.

ACO - ACOs are capable of assuming financial risk for defined populations under contract. As such, there is greater “upside” potential, but there is also significant downside risk for poor performance in managing population health.

INCENTIVE ALIGNMENT

CIN - Most incentives are based on quality and outcome-based factors, to be agreed upon in the payer contracts.

ACO - Members (i.e., medical practices, physicians, hospitals/health systems and other non-acute care facilities) are given quality, outcome and cost-based incentives.

PHYSICIAN COMMITMENT

CIN - Performance expectations are well-documented in CIN arrangements, and clear action steps for addressing underperformance are an integral part thereof.

ACO - Performance expectations are well-documented in ACO arrangements, and clear action steps for addressing underperformance are an integral part thereof.

HUMAN RESOURCE COMMITMENT

CIN - Requires significant personnel commitments to deal with various operational requirements (e.g., training, case management, technology maintenance and payer contracting).

ACO - Generally requires far more significant personnel commitments for these same areas, as compared to CINs.

DATA COLLECTION AND MONITORING

CIN - Processes to collect patient data from various sources (including claim submissions) are an integral part of CIN infrastructure requirements..

ACO - An IT infrastructure that facilitates exchange of patient information across all ACO members is essential. Therefore, technology investment in these initiatives is very significant.

-------------------------------------------------------------

The Bodenger Law Firm is a boutique legal practice providing sophisticated legal services to solo and group physician practices, health systems, behavioral health providers, ambulatory surgery centers, urgent care centers and senior living centers. Our broad range of experience and comprehensive understanding of the healthcare delivery system makes us unique in our ability to assist clients in achieving their business objectives while ensuring compliance with relevant healthcare laws and regulations. Our Firm mission is to provide sophisticated legal services at least equal to “big firm” quality standards, at a fraction of the cost through extremely competitive hourly rates, as well as fixed fee, retainer-based, contingency and other creative billing arrangements.

02/14/2017

IMPLICATIONS OF TRUMP'S AFFORDABLE CARE ACT EXECUTIVE ORDER

On January 27, 2017, President Trump signed his first executive order relating to the Affordable Care Act (the “Act”). The executive order directs the Secretary of the Department of Health and Human Services and all government agencies to “…exercise all authority and discretion available to them to waive, defer, grant exceptions from or delay the implementation of any provision or requirement of the act that would impose a fiscal burden on any state or a cost, fee, tax, penalty or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare insurance, purchasers of health insurance, or makers of medical devices, products or medications.” The executive order’s stated purpose is “…to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to allow the states more flexibility and control to create a more free and open healthcare market.”

Trump’s executive order is a clear message that he plans to repeal and replace the Act. Dismantling unpopular provisions of the Act will be easy compared with the difficult task of symbolically unwinding the federal law, while preserving the key aspects that have enormous economic and political consequences, certain of which are discussed below.

Preexisting Conditions

In the recent past, Trump has stated that he would seek to maintain the “pre-existing condition” requirement that prohibits payers from excluding individuals with existing illnesses or conditions. Republican plans for repealing the Act also maintain this protection of insureds with pre-existing conditions.

Desire of Insurance Companies to Underwrite Coverage in Exchanges

While the health insurance industry is predicted to remain fairly stable through early 2018, the potential loss of subsidies to both beneficiaries and payors could cause them to abandon the individual marketplaces altogether. The prospect of a lesser number of participants in the individual marketplaces would likely defeat the often-cited GOP policy proposal of enhancing competition among health insurers by permitting the sale of insurance across state lines
Individual and Employer Mandate(s)

A key element of the Act requires most individuals and employers with more than 50 full-time employees to obtain “minimum essential healthcare coverage” or become subject to a penalty tax. The controversy surrounding these mandates have caused some individuals and small businesses to accept the penalty because it is less costly than the cost of coverage. This executive order permits individuals and small employers to be exempted from this provision. It is feared, however, that the relaxation of the individual and employer mandates will cause a significant increase in the number of uninsureds, which will force healthcare providers to continue shifting costs to insured populations. Payors expect that the relaxation of these mandates will likely cause healthier (i.e., younger) individuals to opt not to purchase insurance, thus making it more expensive to insure those who require insurance (i.e., the aged and those who have pre-existing conditions). This result is expected to increase the cost of health insurance across the board.

Medicaid Expansion by States

Conservative states face the difficult choice between their general opposition to federal control versus the availability of significant federal subsidies for Medicaid program expansion . Many Medicaid programs are poorly administered, demonstrate cost overruns and result in significant state deficits. Though certain states have developed successful Medicaid programs, it is expected that a number of states will simply abandon Medicaid expansion.

-----------------------

It will be important for the new administration to build on the valuable lessons learned under Obamacare, rather than just dismantling the Act in its entirety.