House passes ACA replacement, provider groups express concerns

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The U.S. Capitol
The U.S. Capitol

As health leaders in the government praised the Affordable Care Act replacement passed by the House of Representatives on Thursday, organizations representing senior living operators expressed concerns that it will harm residents and the healthcare system that serves them. And one group outlined a possible path forward.

The House passed the American Health Care Act by a 217-213 vote, with 20 Republican members and all Democrats voting against it. As written, the bill, which moves to the Senate now, would change Medicaid funding from being open-ended to being distributed to states on a per-capita or block grant basis. Cuts to Medicaid are expected to total more than $800 billion over 10 years.

The legislation, if passed as currently written, also would allow insurance companies to charge adults aged 50 to 64 five times what they charge younger adults for the same coverage; under the ACA, they are limited to charging three times as much. And insurance plans effectively could charge higher premiums for those with pre-existing conditions such as diabetes, heart disease, high blood pressure, Alzheimer's and Parkinson's.

Health and Human Services Department Secretary Tom Price, M.D., described the bill as “a victory for the American people.”

“It is the first step toward a patient-centered healthcare system that will provide Americans access to quality, affordable healthcare coverage, empowering individuals and families to choose the coverage that best meets their needs, not what Washington forces them to buy, and equipping states to address the diverse needs of their most vulnerable populations,” he said in a statement.

“Patient-centered” also is how Centers for Medicare & Medicaid Services Administrator Seema Verma described the bill. “It is important that our most vulnerable citizens, the aged, the infirm, the blind and the disabled have more choices, greater access and peace of mind when it comes to their healthcare,” she said in a statement.

The American Health Care Association/National Center for Assisted Living and LeadingAge, meanwhile, urged the Senate to ensure Medicaid access for older adults and people with disabilities, with LeadingAge calling on the Senate to reject the bill.

“LeadingAge opposes changing Medicaid to a per-capita cap program and slashing Medicaid spending by nearly $840 billion over 10 years,” the organization said in a statement to McKnight's Senior Living. “We remain concerned that this bill also removes key provisions to protect older people and those with serious illness.” The organization also cited the need for a score from the Congressional Budget Office.

A CBO analysis of a previous version of the bill found that it would have cut Medicaid spending by approximately 25%, raise premiums on older, poor Americans by more than 750%, and result in 14 million more people becoming uninsured in 2018 compared with the number of insured under the current law. The independent agency had not completed an analysis of the revised legislation at the time of its passage.

“Medicaid is a lifeline to millions of patients, residents, and families, and keeps the doors open in thousands of facilities across the country,” AHCA/NCAL President and CEO Mark Parkinson said in a statement to McKnight's Senior Living, noting that the bill makes “significant changes” to Medicaid funding.

What's next

Former Senators and government officials and others on the Bipartisan Policy Center's Expert Panel on the Future of Health Care called for a “thoughtful and transparent” policy-making process that includes congressional hearings and the opportunity for bipartisan input as the healthcare reform debate moves to the Senate. The American Health Care Act passed the House without any such hearings.

“Cooperation across party lines is critical to creating legislation that will be sustainable over the long term,” group members said in a statement, also calling for CBO analysis. “The current political debate on healthcare is in part the result of the inability of the parties to work together and compromise. A fully partisan result this year will exacerbate existing divisions and make it more difficult to find a lasting solution.”

The BPC panel includes former Senate Majority Leaders Tom Daschle (D-SD) and Bill Frist, M.D. (R-TN); former Acting CMS Administrator Andy Slavitt; former Health Care Financing Administration Administrator Gail Wilensky; Avik Roy, BPC senior adviser and president of the Foundation for Research on Equal Opportunity; Cindy Mann, former director of the Center for Medicaid; James Capretta, resident fellow, Milton Friedman chair, AEI; Alice Rivlin, senior fellow, Center for Health Policy, Brookings Institution; Sheila Burke, BPC fellow and strategic adviser, Baker Donelson; and Chris Jennings, BPC fellow and president of Jennings Policy Strategies.

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