After Senate Republicans unveiled a draft of their health care plan last week, home health groups were eager to analyze how the bill, named the “Better Care Reconciliation Act of 2017,” could impact the industry—and millions of aging Americans.
In the aftermath of the release, the immediate backlash from the home health industry stemmed from potential cuts to Medicaid. While the Senate version of the bill has not yet been scored by the bi-partisan Congressional Budget Office (CBO), the House version would reduce Medicaid financing by more than $800 billion over a decade.
“Much of the impact will be to those agencies that are providing service to the Medicaid populations,” Joy Cameron, vice president of policy and innovation at ElevatingHome, told Home Health Care News. “Much of the ongoing focus will be in helping agencies illustrate the high-quality, cost-effective health care that home-based care provides in their communities. This legislation will have repercussions throughout all populations—not just seniors and those with disabilities, but from the youngest to the oldest.”
Similarly, for other industry groups, the potential cuts to the Medicaid program are one of the biggest worries. Though, there is some hope that the current version of the bill will undergo an amendment process that will ensure the safety net of home health care Medicaid benefits does not leave some of the nation’s most vulnerable patients without health care coverage.
“While we wait to see further amendments and changes to the discussion draft, we remain concerned about the impact of the draft bill on home health care patients, who are poorer and sicker than the general Medicare population,” Jennifer Schiller, director of policy communications and research for the Alliance for Home Health Quality and Innovation, told HHCN. “Nearly one in three home health care patients has an income at 100% of the Federal Poverty Level (FPL), and two in three have incomes at 200% of the FPL. Further, over 50% of dual eligible home health care patients require assistance with at least one activity of daily living, and over half also suffer from five or more chronic conditions.”
Care Setting Shifts
The Republican health care plan would fundamentally shift the way Medicaid is financed, by financing the program through per capita caps and enabling states to make their own decisions on how to spend federal dollars. While some groups believe the change in Medicaid financing will encourage states to incentivize institutional care, which is a requirement under Medicaid, others disagree.
Conversely, one of the nation’s largest home health care companies, Almost Family (Nasdaq: AFAM), is more optimistic that restructuring Medicaid financing could give states more freedom to spend their dollars in the post-acute care space—and incentivize home care as a lower-cost setting over institutional care.
“While we have an outward concern at what could be a reduction in the provision of Medicaid benefits to the states, there could be a silver lining for home care, in particularly personal care as well as skilled [home health], dependent entirely upon how the states administer their limited dollars,” Denis Fleming, vice president of government relations at Almost Family, told HHCN. “The silver lining is in the value and quality of home care and its cost effectiveness in its relation to institutional care. States are looking at the savings systems to incentivize better care and keep costs down. Home care naturally becomes a good option.”
With the American Health Care Act (AHCA) approved in the House and the new version of the draft on the cusp of a Senate vote, the long-standing Republican promise to repeal and replace Obamacare is closer than ever—and home health care industry groups are pushing to ensure access to home- and community-based services are prioritized and valued under the new health care law.
“The Alliance remains committed to working with policymakers and the Centers for Medicare & Medicaid Services (CMS) on ensuring high quality care is provided for home health care patients and their families,” Schiller said.
ElevatingHome/VNAA and the National Association for Home Care & Hospice (NAHC) have both signed letters to Congressional leaders advocating for greater access to Medicaid and no signifiant spending cuts to the federal program.
“We have members contacting the Senate currently,” Cameron said of ElevatingHome’s current advocacy efforts. “ElevatingHome is part of several coalitions that are working to activate grassroots efforts across patient populations to discuss the overall impacts of the legislation.”
The Senate bill could come before a vote in Congress as soon as Thursday, media outlets have reported. In a reconciliation vote, Republicans would need 50 affirmative votes and a tie-breaker affirmation from Vice President Mike Pence—a “lower hurdle that has to be crossed,” according to Cameron.
Currently, Republicans have a majority in the Senate with 52 Senators, but at least four have publicly stated they will not vote for the bill without major reforms.
“I do not believe that this is the last draft that will be seen and anticipate that there could be additional modification when the CBO score is available at the beginning of the week.”
Written by Amy Baxter