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 New Version of ACA Replacement Bill Keeps Severe Medicaid Cuts Intact

What is old is new again. Senate Republicans on July 13 released a new version of their Affordable Care Act (ACA) repeal and replace legislation, called the Better Care Reconciliation Act (BCRA), without making any changes to what the long term/post-acute care (LT/PAC) profession called “major flaws” that offer severe cuts to the Medicaid program.

In a statement, American Health Care Association/National Center for Assisted Living (AHCA/NCAL) President and Chief Executive Officer Mark Parkinson said the LT/PAC sector is “extremely disappointed” in the new draft. “If signed into law, the BCRA would still cause undue harm to the nation’s long term care sector, including the millions of patients, residents and families, and the providers who care for them,” he said.

This is because the new version of BCRA, like the previous iteration, slashes the Medicaid growth rate, which Parkinson said ignores “the realities of treating our country’s most vulnerable citizens.”

“When the growth rate formula change is fully implemented, it will amount on average to a cut of $600,000 per building per year. The reduction of provider taxes will wreak havoc on states’ budgets in the years to come, tying the hands of state governors and legislatures, and amounting to an average additional cut of $100,000 per building per year,” he said.

The combination of these two provisions will put many nursing centers “under water” at a time states are just beginning to see substantial growth in the number of older adults who will need long-term services and supports. 

“We urge senators to vote against this legislation and hope they will consider that one-third of everyone over 65 will enter a nursing center at some point, and three-fourths of those people will outlive their resources and rely on Medicaid to pay for their care,” Parkinson said. “We need the numbers to add up. Unfortunately, in today’s version, they are far off the mark.” 

Echoing these sentiments, Scott Tittle, executive director of NCAL, said in a statement that “despite weeks of consistent warnings from providers and patient advocates alike, this bill still fails to uphold our nation’s commitment to vulnerable seniors and individuals with disabilities.”

He added that having a robust mix of home- and community-based services, including assisted living communities, as well as traditional settings gives patients choices and, ultimately, the government savings.

At a localized level, the Evangelical Lutheran Good Samaritan Society in South Dakota, which operates 33 nursing facilities and independent and assisted living facilities, told the Argus Leader newspaper in that state that Medicaid cuts envisioned in the BCRA would cost them millions over the next two decades.

The shrinkage of the group’s primary funding source would significantly impact its ability to keep its doors open, let alone admit more seniors,” according to the report, quoting the society’s government relations Director Dan Holdhusen.

In an interview with Provider, Deborah Chollet, senior fellow, Mathematica PolicyResearch, said while nursing facilities have long decried the reimbursement rates they are paid under the Medicaid program, the changes in the Senate bill would make those funding gaps pale in comparison.

“Zero is worse,” she says, commenting on the chance that states will not be able to fund all of the various segments that demand attention under Medicaid, from children, to low-income adults, to the elderly and those with disabilities.

The new draft of the BCRA, which is technically a revamped version of the House-approved American Health Care Act (HR 1628), has not been assessed by the Congressional Budget Office (CBO), but the first BCRA was. In that score, CBO said some 22 million Americans would lose health insurance over the 2016-2027 period and Medicaid would see federal funding cut by $772 billion over that same 10 years, and more in later years.

What happens next to the BCRA is not clear. Senate Republican leaders want to hold a procedural vote on the proposal next week, setting the stage for a final vote shortly thereafter. Senate Majority Leader Mitch McConnell (R-Ky.) has already pushed back the traditional Senate August recess to at least the middle of the month in order to allow for more time to work on the Trump administration’s legislative agenda, including the health care bill.

The new BCRA also adds $45 billion to fight opioid addiction. But, Chollet says, this sets up an ominous scenario where people with pre-existing conditions or serious diseases, like cancer, would be considered less worthy of coverage than opioid addiction as a result of the cuts in the overall bill.

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