Senate Health Care Bill Pulls Back Medicaid Spending

Senate Republicans released a “discussion draft” of their health care bill to repeal and replace the Affordable Care Act (ACA), informally known as Obamacare. The bill, while similar in the House version passed in May, goes even further in its cuts to Medicaid funding—and potential impacts to home heath care.

“The Senate bill—once promised as a top-to-bottom revamp of the health bill passed by the House last month—instead maintains its structure, with modest adjustments,” The New York Times reported.

One of the biggest adjustments likely to impact the home health care industry is deeper cuts to Medicaid through a new financing structure.


Medicaid Financing

Chatter surrounding the Republican health care plan as it pertains to home health care has largely been focused on the way Medicaid would be financed. The Senate bill, like the House version, would phase out Medicaid expansion, which was adopted by some states under the ACA. In addition, the Senate bill would finance Medicaid in the future through per capita caps based on the Consumer Price Index.

The House version of the bill would reduce Medicaid funding by more than $800 billion over the next decade, the nonpartisaion Congressional Budget Office (CBO) found. President Donald Trump’s  budget proposal went even further, cutting an addition $616 billion in Medicaid spending over time.


Medicaid expansion has increased access to home health care and personal care services for beneficiaries, as well as boosted health insurance coverage for 500,000 workers in the industry, according to research from Paraprofessional Healthcare Institute (PHI).

Caring Across Generations, an advocacy group for families, caregivers, people with disabilities and aging Americans, was one industry group to denounce the bill and its deep Medicaid funding cuts on Thursday.

“The bill is so out of touch that it can hardly be called a health care bill,” Josie Kalipeni, policy director for Caring Across Generations, said in a statement. “It slashes Medicaid, just as the Elder Boom is relying on the long-term care supports Medicaid provides. …It eviscerates health care coverage that caregivers and the care workforce rely on to keep themselves healthy. And twenty-four million Americans stand to lose insurance.”

Other industry groups have been up in arms over the prospect of such a deep reduction in Medicaid funding. The National Association for Home Care & Hospice (NAHC) recently joined other organization in penning a letter to U.S. Senate leaders Mitch McConnell (R-KY) and Minority Leader Chuck Schumer (D-NY) opposing the Medicaid financing change as outlined in the Republican plan, in addition to any cuts to Medicare.

“Medicaid is a lifeline for 7 million low-income seniors,” NAHC stated on its website. “The AHCA’s cuts to the program would impact families across this country—including middle-class families—who have already spent down their resources paying out of pocket for long-term care and who rely on Medicaid for critical home and community-based services (HCBS), using home care or other services for a family member with disabilities.”

Other Changes

Beyond making fundamental changes to the Medicaid program, the legislation also has significant changes that roll back Obamacare-era progressive health care reforms.

An AARP analysis has already determined that switching Medicaid financing to a per capita system would not meet the growing needs of an aging population. More than 700,000 home health and personal care aides could also lose their jobs, according to a recent report by LeadingAge and the Center for Consumer Engagement in Health Innovation.

The bill would likely have an impact on immigrants, Vox reported on Thursday, as legal immigrants would not have access to subsidies to help pay for health care insurance on the individual market. Immigrants make up a significant part of the direct care workforce, including home health aides, personal care aides and nursing assistants; 28% of home health aides are immigrants, according to research from the PHI.

Notably, the legislation also guts the essential benefits requirements that came into effect under the ACA, a list of benefits that health care insurance plans must carry at a minimum. Seniors would also likely pay significantly more for insurance, the Times reported.

Passage of the bill is unclear at this point; several GOP senators stated on Thursday they may not support the bill as it is written and are not ready to vote on the matter. While the bill cuts Medicaid expansion, some Senators are opposed to the legislation because it does not go far enough in repealing Obamacare provisions.

Republicans are pushing through the legislation through the reconciliation process, under which the bill could be approved with only 50 affirmative votes and a tie-breaking vote from Vice President Mike Pence. McConnell has signaled he intends to bring the legislation to a vote next Thursday, June 29, ahead of Congress’ recess before the July 4 holiday.

The legislation has not yet been scored by CBO, but the Senate Republican leadership has been sending provisions of the bill to the agency to fast track an analysis of the financial impacts.

Written by Amy Baxter

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