Gear up for another healthcare payment fight

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Elizabeth Newman
Elizabeth Newman

Watching the GOP try to force through its latest healthcare reform plan, which would once again hit Medicaid hard, I was reminded of something my mother used to jokingly say: “It's like deja vu all over again.” Trust me, I know how tired you are, but you cannot assume this bill will fail. 

The Graham-Cassidy bill, named after Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), with additional co-sponsors of Dean Heller (R-NV) and Ron Johnson (R-WI), is being pushed for a vote by the end of the month through a Senate budget procedure process.

While you can dig into the details here and here, the big takeaways for long-term care include redistributing federal funding from Medicaid expansion to non-expansion states (basically penalizing states that broadened coverage) and setting a Medicaid per-enrollee cap as the default for federal financing based on different inflation rates.

Not surprisingly, most in the industry believe this translates into less Medicaid funding for providers already hemorrhaging money. Any potential cut to Medicaid has been met with a big thumbs-down from both long-term care  and other healthcare providers and even a few Republican governors. In a letter sent Tuesday signed by, among others, Gov. Bill Walker of Alaska and Gov. Brian Sandoval of Nevada, the governors asked for Congress to “renew support for bipartisan efforts to make healthcare more available and affordable for all Americans.”

You can feel the governors' exasperation in the letter, given how many citizens — including those in the healthcare industry — have long since moved on from hope of an Obamacare repeal. That same tone came across Tuesday when I spoke with the notably amiable Tom Coble, chairman of the American Health Care Association.

“We've lived through this Medicaid battle and it's not over,” he said. “Now we've got the Cassidy bill that is up again and it's the same thing with Medicaid reform.”

Coble understands the frustration — “no one wants healthcare reform more than those of us involved in healthcare” — but he says the Medicaid changes in the bill are not the way to go.

“It has to be done the proper way. Otherwise, it will take everybody out,” he said.

In a release, AHCA pointed out that the bill “once again tries to solve the complicated question of healthcare reform by slashing hundreds of billions of dollars from the Medicaid program that funds essential care for the aged and disabled.”

While we don't know the full impact of the bill because — fun fact: Senate majority leaders want to vote on it without a Congressional Budget Office score — AHCA says the reduction in provider assessments alone would result in billions less to long-term care each year.

“Reducing provider taxes will devastate state budgets, amounting to an average additional cut of nearly $200,000 per center each year,” the statement reads. “Medicaid already underfunds nursing center care by $7 billion annually. … When combined with these Medicaid provisions, the Graham-Cassidy bill would force many nursing centers to close their doors.”

In an earlier conversation with AHCA CEO Mark Parkinson, I remarked that another healthcare executive had said recently how it was hard to get Congress to focus on its issues. Parkinson disagreed with that assessment, noting how involved AHCA had been, commendably, with fighting back against the American Health Care Act earlier this year. But he agreed the industry has struggled to garner interest in more specific details around long-term care, such as pushing back Phase 2 of rules of participation regulations.

With this latest round of Obamacare targeting, not to mention the other various national crisis on the minds of lawmakers, I have little hope of long-term care making legislative progress on much this year — other than stopping this bill. It's another round of fighting, but it's worth it.

Plus, while organizations will offer their talking points, here are mine: The lawmakers sponsoring this bill and those who might support it need to remember from where, and why, they are elected. An assessment from the Center for Budget and Policy Priorities has Heller's state of Nevada potentially losing $639 million in federal funds by 2026, while Cassidy's state of Louisiana would lose $2.3 billion. It's hard to believe a Cassidy advisor's argument that the bill could bring money into the state. But if you do, I think we all would agree that money would be unlikely to reach struggling nursing homes in the bayou.

Providers must remind lawmakers that their job is to protect the interests and bring the best parts of their state or district to Washington, D.C., not to operate out of fear of being berated by the president.

A “win” that demolishes the skilled nursing industry is no kind of win at all.

Follow Senior Editor Elizabeth Newman @TigerELN.





















Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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