The American Health Care Act (AHCA)—broadly known as Trumpcare—would bring about sweeping Medicaid changes that could limit access to care for many Americans, and the legislation to replace and repeal Obamacare would also hit the home health care labor force.
Between 305,000 and 713,000 home health aides and personal care sides would lose their jobs under the AHCA, according to a recent report by LeadingAge and the Center for Consumer Engagement in Health Innovation. The analysis comes at a time when millions more home care workers are estimated to be needed in the coming decade—the aging population will require an addition 1.1 million direct care workers by 2024, according to the Bureau of Labor Statistics.
Home health care aides and personal care aides would be directly impacted by the shift in Medicaid funding in the health care bill, which would transition Medicaid to a per capita cap system. Per capita caps provide states with an aggregate amount of funding based on the number and category of eligible beneficiaries.
“The resources to pay for [home- and community-based] services and attract workers into this sector would decline under a per capita cap system,” the report reads. …”A shift to per capita caps has the potential to result in significant decreases in home health aide and personal care aide jobs as there would be fewer resources available to pay these workers, even as the need for their services continues to grow in the years ahead.”
The legislation would also have a negative impact on informal caregivers, who help provide care for family members at home.
“A per capita system would add strain to the tens of millions of unpaid family caregivers who provide significant assistance to their family members and who already experience heavy financial, emotional and physical tolls,” the report reads.
Shift to Institutional Care
The health care law would also likely “cause a shift away from home and community based services toward institutional care such as nursing homes,” the report reads.
This is because home and community based services are not mandatory under Medicaid rules; states have to make the choice to direct funding and support for these care settings. However, institutional care is mandatory under Medicaid, but the largest share of all Medicaid services is spent on home and community based services, and states have been directing more funding away from institutional care over the years.
The new policy would create an enormous disruption to these services for beneficiaries, or their elimination altogether, the report warns.
“The result would be that some individuals would be forced into institutional settings, others would join waiting lists, family caregiving efforts would come under increased strain, and others would go without needed care,” the report states.
States that already spend a greater proportion of Medicaid dollars on home- and community-based services compared to institutional care, such as Minnesota, would see the greatest service disruption, as they would have to reallocate funds to nursing homes.
The AHCA was approved by the House in early May, and the Senate is reportedly working on its own version. However, the Senate has yet to hold a hearing on the bill or disclose details of the legislation. Congress goes on recess before the July 4 holiday, and industry groups have signaled that the legislation has a better than 50-50 chance of passing before then.
Written by Amy Baxter