During the Obama administration, CMMI launched more than 40 projects. More than 207,000 health care providers have participated in the Obama-era models, and more than 18 million patients have been impacted by them, according to a December 2016 CMMI report to Congress. Some of those projects, especially those that were large in scale and had mandatory participation, faced fierce pushback from stakeholders and the GOP, prompting House Republicans to make abolishing CMMI a top priority in their 2016 policy platform. “There had been a sense by many of the Republicans in Congress that this was a way to circumvent congressional approval of effectively changing Medicare payment,” Gail Wilensky, a health economist who oversaw the Medicare and Medicaid programs under George H.W. Bush, said in a March 6 phone interview. But since Republicans took the White House, calls for repealing the office have faltered. The Centers for Medicare and Medicaid Services has made some changes to CMMI, such as rolling back three mandatory models last year that had been vilified by provider groups and GOP lawmakers. But the center’s organizational structure remains in place, and it continues to test alternative payment models. President Donald Trump has yet to appoint a permanent director to lead the center.
Despite trying to aggressively undermine Barack Obama’s Affordable Care Act (ACA), the Trump administration is also seeking to advance one of its own health care priorities. The Centre for Medicare and Medicaid Innovation (CMMI) was set up under the ACA to experiment with alternative provider payment models for government health schemes, especially Medicare, without input from Congress. Over 40 projects were launched by the CMMI during the Obama era and more than 10 million patients were impacted by them, a 2017 report to Congress showed. Some of the schemes came under fierce criticism from the GOP, with some House Republicans declaring the abolishment of the CMMI a top priority. But calls for repealing the office have lessened since Donald Trump took the White House. The CMMI’s organisational structure remains the same and it continues to test other payment models, despite the Centers for Medicare and Medicaid Services rolling back three mandatory models in 2016. Senate Finance Committee Chairman Orrin Hatch, R-Utah, said that despite a “lack of accountability” under Obamacare, the CMMI had the “potential to serve as an innovation center that can improve the delivery of health care across the country”. Meanwhile Patrick Conway, former director of the CMMI, said he thought Health and Human Services Secretary Alex Azar was “truly committed” to driving change in the health care system. Trump has yet to appoint a permanent director to lead the CMMI but Azar has pledged to move forward with alternative models. Speaking at events held by the Federation of American Hospitals and America’s Health Insurance Plans (AHIP), Azar said the government would use tools such as the CMMI to “drive real change in our system”.