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The Failure of the Repeal and Replace: Missed Opportunities for Home Health

Posted on Thursday, March 30, 2017 3:47 PM

Due to failed attempts to gather support in the GOP-controlled House of Representatives, House Speaker Paul Ryan withdrew the American Health Care Act (AHCA) to repeal and replace the Affordable Care Act (ACA) before a vote could even be held.

On March 15, 2017, NAHC wrote a letter to Speaker of the House Rep. Paul Ryan (R-WI) and House Minority Leader Nancy Pelosi (D-CA) to express their concerns that the American Health Care Act (AHCA) does not prioritize home care.

“For example, the bill eliminates an important Medicaid option, the Community First Choice benefit, which encourages states to shift spending to cost-effective home care” despite the fact that numerous states have embraced that new benefit. “Still, the failure of some states to offer a robust home care option is evident even with the financial incentives under the Community First Choice program. The current per capita caps formula will be a roadblock to the expansion of access to home care in Medicaid. The elimination of the Community First Choice program is, as well.”

Additionally, the letter included that even though most states offer hospice services to their Medicaid populations, this is still optional and “absent any requirement that states offer a meaningful end-of-life benefit, imposition of caps or other limits on funding for Medicaid services will create tremendous pressure on states, and will place existing coverage of hospice care at serious risk.”

NAHC advised the House of Representatives to make changes to make sure that access to home health was a priority of the new legislation. However, those concerns were never addressed.

A week after the March 15 letter was sent, NAHC also signed a letter to Reps. Ryan and Pelosi opposing provisions of the AHCA that undermined the long-term health of the Medicare program.

The AHCA would have:
• Repealed the ACA payroll tax increase on wealthy Americans
• Reduced Medicare Hospital Insurance (Part A) Trust Fund revenues by $117 billion between 2017 and 2026, as a result of the tax increase
• Resulted in the Trust Fund’s insolvency by 2024, when combined with increased Medicare payments to hospitals on behalf of newly-uninsured people

NAHC opposed then and continues to oppose any tax cut for the wealthy that sacrifices the future solvency of the Medicare program.

According to calculations from the Congressional Budget Office (CBO), AHCA changes to Medicaid would have cut $880 billion in federal funding over the next ten years, leading to 14 million Americans losing their health insurance.

NAHC feels that home and community-based services will experience certain effects from the cuts since those services are optional, while nursing home coverage is mandatory.

Even though Speaker Ryan acknowledged the Affordable Care Act to be “the law of the land” for the foreseeable future, the House leadership claims the fight to repeal and replace “Obamacare” will continue.

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