As the Republican health care plan undergoes changes before its day on the Senate floor for a vote, health care providers are tracking how the legislation, the Better Care Reconciliation Act, could impact the skilled nursing field.
While potential cuts to Medicaid — ranging from estimates between more than $770 billion and $810 billion — have seen the biggest outcry from the health care industry, fundamental changes to Medicaid financing have little to do with the Affordable Care Act (ACA), the law on which Republicans staked their 2016 campaign promises.
However, there are some signifiant rollbacks in ACA, or Obamacare, regulations within the Republican health care plan.
Here are two Obamacare provisions that could be eliminated under a new health care law that could impact the skilled nursing sector:
1. Elimination of employer mandate
One of the most cheer-worthy provisions in both the House and Senate versions of the health care legislation is a repeal of the employer mandate, an ACA-era regulation that requires qualified businesses to offer health insurance options for full-time employees.
The mandate had a major impact across many small and independent businesses with 50 or more full-time employees, and hit providers that offer Medicaid services particularly hard, according to Bill Dombi, vice president of law at the National Association for Home Care & Hospice (NAHC). While NAHC focuses on advocating for relief to home-based care providers, the mandate impacted eligible skilled nursing providers as well.
Due to the low margins of operation and low reimbursement rates for Medicaid operators, many companies couldn’t afford the additional cost of providing health insurance to their employees. As a result, providers changed their operations to avoid the requirement.
Some of these steps included limiting the number of employees to remain under the 50 full-time employee threshold, as well as limiting hours to under 30 per week to keep employees just under full-time status, according to Dombi.
Without the mandate, Medicaid providers will see a positive change in the cost of running their businesses, industry stakeholders agree.
2. Elimination of the Community First Choice program
Another significant impact of the legislation is that it would eliminate a the Community First Choice federal program, which provides additional Medicaid funding for in-home care providers in some states.
Some sources say a reduction in Medicaid spending could influence more funding to shift away from home- and community-based services (HCBS), as they are not required under Medicaid. States, needing to provide more services and care with less funding under the Republican health care plan, would likely fund required services first, like skilled nursing care.
“It’s a program that provides additional federal support to rebalance Medicaid spending toward home- and community-based services (HCBS),” Dombi said. “It’s a 6% federal match.”
Only eight states — California, Connecticut, Maryland, Montana, New York, Oregon, Texas and Washington — have approved plans for the program, which allows states to provide home and community-based attendant services and supports to Medicaid beneficiaries.
And the overall cost impact of the program is significant. When the program first rolled out, the Congressional Budget Office (CBO) revealed it would cost $13 billion over time. Now, the cost is even higher.
“The CBO scored it as a $19 billion reduction in Medicaid support,” Dombi said. “That’s a $19 billion reduction for home care.”
Senate Republicans postponed a vote on the health care bill, which was originally planned to occur before the July 4 holiday. Sen. Majority Leader Mitch McConnell postponed the vote because Republicans did not have the required simple majority of 50 votes — plus a tie-breaker affirmative vote from Vice President Mike Pence. The bill is expected to undergo changes over the next few weeks to appease Senators who are on the fence over their votes.
Written by Amy Baxter