ACA replacement would harm providers, caregivers, elderly, groups say

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ACA replacement would harm providers, caregivers, elderly, groups say
ACA replacement would harm providers, caregivers, elderly, groups say

Long-term services and supports providers, Medicaid beneficiaries and professional caregivers would suffer if the bill that Republicans in the House of Representatives proposed Monday to replace the Affordable Care Act becomes law as written, according to organizations advocating for senior living operators and workers.

The legislation, being called the American Health Care Act, would convert Medicaid financing to a capped allotment of federal funds to the states on a per-capita basis and would “fundamentally destroy the Medicaid program as we know it,” said LeadingAge President and CEO Katie Smith Sloan.

“Medicaid is the most important public source of financing for long-term services and supports,” she said. “This bill threatens our rapidly aging population with the loss of coverage for the health and long-term care seniors need. It is the wrong policy at the wrong time.”

ACA and direct care workers

A new issue brief from the Paraprofessional Institute, “The Impact of the Affordable Care Act on Health Coverage for Direct Care Workers,” finds that under the Affordable Care Act:

  • 500,000 direct care workers gained health coverage between 2010 and 2014, representing a 26% drop in the uninsured rate.
  • Health coverage made possible through the expansion of Medicaid increased 30% among direct care workers between 2010 and 2014.
  • In states that expanded Medicaid, the uninsured rate fell by 33%, compared with 21% in states that did not expand Medicaid.
  • Home care workers, 37% of whom live below 138% of the federal poverty level, made the most significant gains, with the uninsured rate dropping from 35% to 26%.

PHI released the issue brief as part of its #60CaregiverIssues campaign, a two-year public education effort, launched in early February, that seeks to identify 60 solutions to address the growing shortage of paid caregivers across the country.

Under the GOP plan, states that expanded their Medicaid programs under Obamacare would receive complete federal funding for them through Jan. 1, 2020. Monies then would be reduced for beneficiaries who had not enrolled in the program by then. States that did not expand their Medicaid programs would receive a fixed amount, $10 billion, over five years under the proposed legislation.

The AHCA bill also would permit health insurance companies to charge older adults who don't yet qualify for Medicare up to five times as much as they charge younger ones for coverage. The ratio under the ACA, by comparison, is 3:1.

Paraprofessional Healthcare Institute President Jodi M. Sturgeon cited a new PHI study, published Tuesday, that found that 500,000 direct care workers — personal care aides, nursing assistants and home health aides — gained coverage under the Affordable Care Act, primarily through the expansion of state Medicaid programs.

“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,” she 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. More than one-third of Medicaid spending goes to support these services.”

Many assisted living communities provide home- and community-based services to their residents through Medicaid waivers.

Caregivers who don't have health coverage would be more likely to miss work or leave the caregiver workforce, Sturgeon said. “With unprecedented workforce shortages already affecting long-term care, we cannot afford to take away the health benefits that are so crucial to recruiting and retaining these workers,” she said. (See the sidebar for additional information about the PHI study.)

Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, also expressed concern about potential Medicaid cuts.

“The bill …  will sharply reduce Medicaid funds across the board for all beneficiaries, making it harder than ever to maintain access to care for the most vulnerable in our society,” he said.

AHCA/NCAL, Parkinson said, “strongly encourage Congress to protect Medicaid access for seniors and people with disabilities in the Obamacare repeal-and-replace effort.”

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