NAHC: Trump Administration Could Bring Sweeping Medicare, Medicaid Changes

As the dust has started to settle in the aftermath of the election on Nov. 8, some policy ideas that could heavily impact the health care system are starting to come to light. And not all of the changes could be good for home health care and hospice.

While the potential rollback in regulations could benefit home health care providers, new policies to the greater health care system could have a much deeper effect. Specifically, Republican leaders have begun touching on significant potential changes to Medicare, even though President-elect Donald Trump said he would not touch Medicare during his campaign.

However, just days after being elected, Trump seems more keen on making some key policy changes, though his positions have been slim in their details.


‘Better Way’ Proposals

For the best prediction of what Medicare changes could look like, home health and hospice groups are taking a harder look at the “Better Way” plan by Speaker of the House Paul Ryan (R-WI), executives from the National Association for Home Care & Hospice (NAHC) said during a recent web event on the potential policies the new administration and Republican-controlled Congress could put forth.

“Medicare reform is based around Ryan’s ‘Better Way[plan],” Bill Dombi, president of law for NAHC, said during the web event. “It would be a dramatic change. It would take the traditional Medicare program, which entails individuals’ eligibility based on their paying into the system and reaching a certain age, and turn it from a basic health insurance-type plan to a premium support plan.”


One possible outcome is that beneficiaries would receive a Medicare contribution to purchase health care in the private market. The details of these changes are still uncertain.

One of the most concerning proposals is to merge Medicare Parts A and B, NAHC executives say. Doing so would integrate post-acute care providers with other health providers, including payment sharing. This could result in a return of copayments and deductibles for home health care beneficiaries, which were eliminated in the 1970s.

“A merger of Part A and B has been rejected by Congress many times,”   Val Halamandaris, president of NAHC, said during the web conference. “Why? Because it doesn’t make any sense.”

Beyond Medicare changes that could impact home health care providers and beneficiaries alike, proposals to make fundamental changes to Medicaid are being floated, as well. What is most likely to happen in terms of Medicaid is a fundamental change in its financing. In his campaign platform, Trump supported block granting Medicaid funds to states.

The result could be less funding for states over time as medical costs continue to inflate. However, states may have more flexilibity in their Medicaid financing.

“Within Better Way, [Ryan] proposed to block Medicaid on per capita costs,” a NAHC executive said during the panel. “One reason we’re very concerned is [that what was shown in] a recent budget how much they’re paying per enrollee over a 10-year period would take away $1 trillion for states in Medicaid funding.”

At this time, there is still a lot of uncertainty about what will change in the health care system and how home health care will be impacted. With many leadership positions up for grabs, ideas are plenty, and not all will stick.

“Everybody seems to be dumping their ideas on what can possibly happen,” said Richard Brennan, vice president for government affairs at NAHC.

Written by Amy Baxter

Photo: “Donald Trump” by Greg Skidmore, CC BY-SA 2.0

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