President-elect Donald Trump (R) on
Jan. 11 addressed the impending and likely sweeping changes to come for federal
health care policy by declaring his administration would reveal its Affordable
Care Act (ACA) “repeal and replace” plan near the time his nominee to lead the
Health and Human Services Department is confirmed. That nominee, Rep. Tom Price
(R-Ga.), has a confirmation hearing set for Jan. 18.
Trump, speaking from New York during
a far-ranging press conference covering everything from Russian hacking to
inauguration planning, called the ACA a “complete and total disaster,” and
without giving any details said his health care plan would be cheaper and more
beneficial for the American people.
The president-elect’s statements
that he wants to repeal and replace the ACA in near simultaneous fashion runs
counter to what many Republicans in the House and Senate have been saying in
recent days. Repeal may happen relatively swiftly, but there is no known
consensus on what will replace President Obama’s signature health care reform
For example, Sen. Lamar Alexander
(R-Tenn.), chairman of the Senate Health, Education, Labor, and Pensions
Committee, said on Jan. 10 that repealing the ACA should come after a specific
replacement is ready.
To get started, the Senate is
scheduled to vote this week on a timeline to draft repeal legislation, with the
House in line to follow. Democrats have been urging Republicans to release
their legislation even as they decry what seems to be a certain end to the ACA
in its present form.
Amid the conflicting statements on how to proceed on the ACA, the priority
issues for the long term care industry are in place even as the timing and
extent of the Trump-led changes to come are unknown, says Clifton Porter II,
senior vice president, government relations for the American Health Care
Association/National Center for Assisted Living (AHCA/NCAL).
Porter says the top issues for AHCA/NCAL and its members will be divided
into two buckets, the matters that can be changed by regulation and those that
require legislative action. “The potential [for regulatory changes] comes in
three phases once the president is inaugurated. He has an opportunity to
reverse executive orders, which will be phase one,” Porter says.
Phase two will be a process called the Congressional Review Act (CRA),
where Congress and the administration can reverse finalized regulatory actions as
long as they meet certain criteria, he says. “And the third way is through
normal regulatory actions, which essentially will be a process where the new administration
will introduce or propose new regulations that reverse old ones, and that will
be a longer process.”
Even though there are not a lot of direct measures tied to skilled nursing
care centers or assisted living facilities that were part of Obama’s executive
orders, Porter says if Trump eliminates the mandate for a federal minimum wage
for government contractors, that would be important for members offering Veterans
On the CRA track, AHCA/NCAL’s approach is to seek to have the requirements
of participation rule repealed. “Inherent in that as everyone knows is the
arbitration ruling that we are dealing in the courts with now,” he says.
Other regulations that the group would like rolled back are the cardiac
bundled payment program under the authority of the Center for Medicare and
Medicaid Innovation, a part of the Centers for Medicare & Medicaid Services.
There is also the task of closely monitoring and actively being a part of any
discussion on moves to change the payment systems and the structures of the
Medicaid and Medicare programs, Porter says.
As for the ACA repeal and replace debate, he notes that since the ACA did
not aid AHCA/NCAL communities, its possible demise is not going to cost the
industry like it will for other sectors in the health care economy. “We did not
get any coverage of the uninsured like the hospitals did. We didn’t get
subsidies like insurance companies did to provide insurance. We basically got
cut. So repealing the ACA in and of itself does not bring any peril to us or
our members,” he says.
And if certain components of the law are removed, it could be a positive,
he says. “Obviously if the employer mandate is replaced, and there is a high
probability it will, then that will provide our members more flexibility in
their offerings regarding insurance that are potentially less expensive
alternatives,” he says.
The bottom-line issue, however, is restoring the $15 billion (over 10
years) in cuts that long term care lost to help pay for the ACA. “We
essentially were cut to pay for the ACA, and that cut happens every year in
what is defined as a productivity adjustment. Whatever increase we were going
to receive for the year based on inflation is reduced by a certain amount, and
that reduction is a pay-for for the ACA,” Porter says.
“Our ask is simple: If you repeal the ACA, why should we continue to pay
for something that does not exist?”