The Home Health Industry Has Mixed Feelings About the Obamacare Replacement Bill

Posted on Thursday, March 9, 2017 1:48 PM

The GOP’s health care plan has finally been released with mixed feedback from home health stakeholders. The Obamacare bill was released Monday to replace the Affordable Care Act (ACA).

In a press conference Tuesday, Secretary of the Department of Health and Human Services (HHS), Tom Price, called the bill a “work in progress” and made a comment that the bill might undergo some changes. According to conservative groups, they’ve called the bill “Obamacare Lite.” In addition, President Trump tweeted on Tuesday that “phase 2 & 3” of the health care rollout will include more provisions.

The National Association for Home Care & Hospice (NAHC) has described the replacement bill as a “combination of positives, negatives and speculative impacts,” NAHC’s Vice President of Law Bill Dombi told HHCN.

Caregivers Take a Hit
“The House Republican plan to replace the Affordable Care Act raises deep concern for PHI… as well as for paid caregivers around the country and the people they serve,” PHI President Jodi M. Sturgeon said in a statement to HHCN.

Medicaid Changes to Come
“Plans to cut Medicaid spending at the federal level will adversely affect these workers as well as their clients: older Americans and people with disabilities,” Sturgeon said. “Per capita caps on spending will reduce funding for long-term services and supports in home and community-based settings and across America’s nursing homes.”

Care to Beneficiaries
“Medicaid expansion in some states allowed more agencies to care for these new populations and beneficiaries to ensure appropriate, high-quality and low-cost health care,” Joy Cameron, vice president of policy and innovation at Visiting Nurse Associations of America (VNAA), told HHCN.

VNAA stated it will work to promote the role of home-based Medicaid and the need to prioritize it, Cameron told HHCN.

“The speculative part is the proposed shift of Medicaid to a per capita caps program,” Dombi said. “This would limit the amount of federal Medicaid payments to the state while increasing the state’s flexibility in structuring its Medicaid program benefits. That flexibility may favor or disfavor home care. At the same time, the payment cap will restrict the opportunity for home care benefit expansions. As such, the home care impact can vary widely between and among states.”

States will Experience Rate Cuts
“The negative impact in the draft bill is centered around the elimination of the 6% increase in federal Medicaid financial support for home care under the Community First Choice benefit that was created as part of the Affordable Care Act,” Dombi said.

Since the program became available, eight states adopted it—California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington—according to Dombi. Another five states—Arkansas, Alaska, Colorado, Minnesota, and Wisonsin—have submitted applications or are actively considering adopting the Community First Choice benefit program.

“This program was designed to encourage states to rebalance spending on long-term services and supports away from institutional care and toward home care,” Dombi said.

Putting an End to Mandates
“On the positive side, the bill would repeal the ACA employer mandate which has raised home care costs, particularly for companies providing Medicaid and private pay personal care,” Dombi said. “The problems created by that mandate have been compounded by the fact that no state Medicaid program has raised payment rates to cover this added costs.”

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