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 Long Term Care Advocates Set Agenda Amid D.C. Upheaval

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 law.
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 Affairs services.
 
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?”
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