After postponing a vote by one day, the Republican health care bill was pulled from the House floor on Friday, March 24, effectively killing the first attempt to repeal and replace Obamacare.
The plan aimed to replace the Affordable Care Act (ACA), or Obamacare, and make good on a long-standing promise by Republicans. On Friday, Republicans, with control of the House, Senate and White House, fell short of that promise.
The AHCA bill underwent a few amendments before the vote, including scrapping the “essential health benefits” provision, which is a list of 10 benefits insurance plans must currently cover. Another amendment added on Thursday delayed a repeal of a Medicare tax and increased aid to states for maternity and newborn care.
The Republicans’ plan also calls for another two phases of implementation, including a full repeal of the ACA and other reforms. In addition, these phases are not likely to come under a reconciliation procedure, as the AHCA was done.
Analysis from the independent Congressional Budget Office (CBO) found that the first version of the Republicans’ bill would effectively increase the number of insured Americans by 14 million in 2018 and 24 million by 2026. The jump in uninsured in 2018 would largely come from the repeal of the individual mandate, CBO found, but millions more would lose coverage as a result of reduced spending to Medicaid.
However, Health and Human Services (HHS) Secretary Tom Price rejected these estimates, citing that the numbers “defy logic” and fail to take into account the other phases of the plan that have yet to be released.
“These types of assumptions do not translate to the real world, and they do not accurately estimate the effects of this bill,” he said in a statement.
Home health care groups have been hopeful that Price’s stance on regulations, including his opposition to Pre-Claim Review Demonstration (PCRD) and bundled payments, could result in these programs being delayed or put on pause under his leadership.
Impacts on Home Health
Medicaid expansion under the ACA increased home health care utilization, as more Americans were covered for benefits. Home health industry groups, including the National Association for Home Care & Hospice (NAHC), have voiced their opposition to Medicaid cuts.
“Federal cuts to Medicaid brought about by per-capita caps would force states to make painful choices and very likely lead to a reduction in health benefits, the imposition of waiting lists and other restrictions to service—including for the elderly and disabled on Medicare,” the NAHC wrote on its website on March 23. “NAHC is particularly concerned that home and community-based services will be affected by cuts because those services are optional, while nursing home coverage is mandatory.”
Repealing the ACA is anticipated to have several effects on home health care providers beyond the hit to Medicaid. If the AHCA can serve as any indication, caregivers who gained health care coverage under the ACA could see a loss of benefits, as the AHCA was set to eliminate the employer mandate to provide insurance for small businesses. However, the measure could be cost saving to providers.
As a result of repealing Medicaid expansion, the Republican plan was also anticipated to increase the number of patients toward institutional care rather than home care.
NAHC president Val J. Halamandaris penned a letter to House Speaker Paul Ryan (R-WI) and House Democratic Leader Nancy Pelosi (D-CA) stating the association’s concerns of how home care could be compromised if Medicaid spending is scaled back.
“In reviewing the American Health Care Act, there are concerns that access to home care is not a priority,” the letter reads.
Written by Amy Baxter