Senate Republicans released a 142-page “discussion draft” of their plan to replace the Affordable Care Act on Thursday, and former President Barack Obama, under whose administration the ACA became law, said in a Facebook post that it would “ruin Medicaid as we know it.”
Advocacy organizations in senior living also expressed concerns about the Medicaid-related components of the legislation, dubbed the Better Care Reconciliation Act of 2017.
Under the ACA, Medicaid funding is open-ended, with the federal government providing states with matching funds for beneficiaries. The Senate bill, however, like the House’s proposed American Health Care Act, would fund Medicaid by giving states a per capita amount or a block grant. In the Senate version, the funding change would begin in 2021, with the amount growing more slowly than under the House bill, resulting in larger spending cuts overall.
Senate Majority Leader Mitch McConnell (R-KY), in a statement posted on his website, said that the bill will “strengthen Medicaid,” and according to the Senate Committee on the Budget, it does so by “giving states more flexibility while ensuring that those who rely on this program won’t have the rug pulled out from under them.” Senate Minority Leader Chuck Schumer (D-NY), however, noting that President Donald Trump had referred to the House bill as “mean,” said in a tweet that the Senate version is “meaner. It doesn’t ‘have heart.’ It’s heartless.”
The Congressional Budget Office already has said that the House bill would cut federal Medicaid spending by $834 billion over 10 years, causing concerns among senior living providers about their future ability to provide care and services and effects on the workforce. The CBO said it expects to release it assessment of the Senate’s version of healthcare reform early next week.
In the meantime, industry representatives shared their own assessments.
“Home- and community-based services, often provided in America’s assisted living communities, are a critical part of the Medicaid program that allow seniors and individuals with disabilities to receive long-term care in the setting best suited for them,” National Center for Assisted Living Executive Director Scott Tittle told McKnight’s Senior Living on Thursday. “However, the Senate proposes reductions in Medicaid funding significantly worse than the House version that may further threaten access to HCBS because states will have to scale back their programs. At a time when our aging population is rapidly growing and patient choice is preferred, this is not the time to back down on our promise to our nation’s most vulnerable.”
LeadingAge President and CEO Katie Smith Sloan said that the organization “continues to strongly oppose the fundamental changes to the Medicaid program made by both the House and Senate legislation repealing the Affordable Care Act.
“Medicaid is not just for poor people,” she continued. “It is the way middle-class families pay for long-term services and supports. The Senate bill actually cuts funding for Medicaid even more deeply than the House bill in the long run due to a lower annual growth rate.”
Argentum President and CEO James Balda said his organization is “laser-focused on the impact this proposed bill could have on the senior living industry and the older Americans they serve.”
The organization noted that the Senate bill would phase out the extra federal funding provided to states as an incentive to expand eligibility for Medicaid, but it would let states choose an eight-quarter period between 2014 and September 2017 to set as a baseline for future Medicaid payments (the House bill limits it to 2016), which gives states some flexibility in influencing their baseline.
Argentum said it supports the bill’s elimination of the employer mandate to offer insurance to employees as well as the retaining of tax credits to help low-income individuals buy health insurance by basing the credits on income and geography rather than age, an approach that disproportionately affects seniors.
“However, the Senate draft retains language from the House bill allowing insurers to charge older adults five times more than younger people,” the organization noted. Under the ACA, insurers cannot charge adults aged 50 to 64 more than three times what they charge younger adults.
The Senate is expected to vote on the bill before members break for the July 4 holiday. With Democrats unanimously opposed, Senate Republicans need all but two of their party’s members to vote for the bill for it to pass.
“I still hope that there are enough Republicans in Congress who remember that public service is not about sport or notching a political win, that there’s a reason we all chose to serve in the first place, and that hopefully, it’s to make people’s lives better, not worse,” Obama said.
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