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 Senate Delays Vote on ACA Replace Bill Amid Backlash over Medicaid Cuts

​Senate Majority Leader Mitch McConnell (R-Ky.) has decided to delay a vote on the Senate’s Affordable Care Act repeal and replace bill, the Better Care Reconciliation Act, until after the July 4 recess. It is not clear when a vote will occur, but congressional sources say the majority Republicans did not have the votes for the legislation to clear a planned Wednesday procedural vote.
 
The move comes as the long term and post-acute care sector is lobbying hard against severe Medicaid cuts in the legislation, which if enacted would put scores of skilled nursing care centers out of business.
 
Mark Parkinson, president and chief executive officer (CEO) of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said during a June 26 press briefing that two significant changes in the Senate bill, which run counter to the House-approved version of the repeal and replace bill, would dramatically affect funding for skilled nursing.
 
“If these provisions stay in the legislation, the long-term impact of these will be debilitating to the sector and to the people that rely on long term care,” he said.
 
The first change is that the Senate lowered the growth rate that is used to set a cap that each state can spend up to and still be matched by the federal government. “The House bill also had a cap line that started in 2021, but in that cap line it increased every year at the rate of CPI [Consumer Price Index] medical + 1 for the aged, blind, and disabled, and CPI medical for everyone else,” Parkinson said. “So, there was a cap line, but it could grow at a healthy amount, and states could still give increases that would correspond with actual costs without being penalized.”
 
Unfortunately, he said, the Senate version does not have that provision. “The Senate version retains the same cap line as the House bill until 2024 and then it flips to a CPI urban rate. The data indicate that the CPI urban rate over the years has been roughly 2.4 percent. The actual Medicaid cost increases over a similar period of time have been 4.4 percent,” Parkinson said.
 
What all of this means for the nursing center operator is reduced funding that only worsens over time. “If you have a 2 percent differential that then compounds year after year, by the time you get very much further into the progress of the legislation, there’s a dramatic underfunding of all Medicaid providers, including skilled nursing facilities,” he said.
 
After crunching the numbers, AHCA/NCAL data show that if one assumes skilled nursing centers will fare no better or no worse than other health care providers, at 10 years out, each nursing center across the country will be taking a $600,000 cut, in 2016 dollars.
 
“That’s much more than what the average nursing home makes per year. The average nursing home makes $100,000 to $150,000 per year. This change alone puts the sector under water,” Parkinson said.
 
A second change in the Senate bill versus the House legislation would lower the allowable provider assessment. Under current law, states can permit providers to assess themselves up to 6 percent of their revenue and have that matched by the federal government. The Senate version lowers that maximum assessment to 5 percent.
 
In addition to Parkinson’s press briefing, the AHCA/NCAL leader appeared on the NBC Nightly News as part of a segment on the severity of the proposed Senate Medicaid cuts. Within the piece, Jayne Hail, a 74-year-old resident at Burgess Square Health Care and Rehab Centre in Westmont, Ill., described her reaction to the legislation.
 
“It’s really scary, because you don’t know what’s going to happen. If I didn’t have Medicaid, I don’t know where I would go,” she told the news program. “I think that the people who are trying to do the cuts ought to stop and think, what if it was their mother. Where would you want them to be?”
 
John Vrba, CEO of Burgess Square, also appeared in the segment and said, “Two-thirds of residents in long term care facilities rely on Medicaid as their main source of funding,” making the Senate bill a real threat to both residents and providers.
 
At the same time the skilled nursing community was making its push against the Senate bill, the prospects for the legislation dimmed after the Congressional Budget Office (CBO) on June 26 released an assessment, or score, that was roundly reviewed as nearly entirely negative for the Republican proposal. In fact, CNN reported on June 27 that White House sources said the CBO score put the repeal and replace effort “on the threshold” of defeat.
 
In that score, the nonpartisan CBO said 22 million more Americans would be without health insurance by the year 2026 if the Senate plan became law. The agency pegged the federal reduction in Medicaid spending at $772 billion by 2026. The House version of its repeal and replace bill would cut Medicaid spending by 2026 a total of $834 billion if enacted, CBO said in March.
 
Meanwhile, the AARP Public Policy Institute projected figures extending losses over an additional 10 years. According to an AARP blog post June 23, the institute projects that the Senate bill would cut between $2.0 and $3.8 trillion from total federal and state funding between 2017 and 2036.
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