Price says the right things on Medicare, Medicaid

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Elizabeth Newman
Elizabeth Newman

It would be unwise to assume that Rep. Tom Price (R-GA) the likely new head of Health and Human Services, is always going to align with the values of long-term care providers. But in the midst of a whirlwind of news around cabinet appointments, it is worthwhile for nursing home providers to take a deep breath and read about what Price did — and more importantly, did not — say this week.

The Senate Finance Committee members asked a variety of questions Tuesday, including one regarding President Donald Trump senior advisor Kellyanne Conway's comments about moving Medicaid to block grants. Last year, the House Budget Committee, led by Price, proposed block grants, which one analysis indicated would save the government about $913 billion. An earlier Republican plan from 2011, had it been passed, would have cut an estimated $220 billion from nursing home reimbursements through block grants.

But Price indicated to the committee that what he did as a Congressman would not reflect what he might do as HHS Secretary, and he did not reiterate his support for block grants. Plus, on the Medicare side, he didn't indicate a desire to move to privatization.

“I would just convey to the Medicare population of this nation, they don't have reason to be concerned," he said. "We look forward to assisting them in getting the care and coverage that they need."

Granted, it's not a ringing endorsement for Medicare reimbursement dollars flowing to hard-working nursing home providers. But it is better than some of his colleagues' plans for Medicare.

For example, Speaker of the House Paul Ryan for years has put Medicare privatizations as a high priority on his legislative agenda. This would be a radical change for you and the 57 million beneficiaries that often need your services.

The basic idea is senior citizens would receive a set dollar amount for health insurance, but in the latest version of Ryan's plan, instead of vouchers to buy private insurance, the elderly could choose to use their subsidy for traditional Medicare. 

“Starting in 2024, our plan gives future beneficiaries the opportunity to choose from an array of competing private plans alongside traditional Medicare and helps seniors pay for or offset premium costs for the plan of their choice,” according to Ryan's Better Way plan.

Some consumers may shrug and say, “Fine,” but I suspect providers can see the issue. It's not clear how the government would decide how much money a senior received, but it is believed to likely it would be determined by private insurers. The advocates for privatization believe that there needs to be more competition in healthcare and costs would be driven down through this process.

One could say privatization allows seniors to be empowered to make their own choices. The problem, of course, is that seniors would need to look at a variety of insurance options, similar to the way Affordable Care Act customers had to wind their way through different plans. Anyone who has ever navigated those ACA options knows it is overwhelming when you're a healthy 30-year-old, so I can only imagine how it would go over amid the senior population.

One Brookings Institution analysis found that by 2030, “the overall cost of care for the Medicare population would be at least 41 percent higher than it would be under Medicare and the amount that enrollees would have to pay directly would more than double.”

Plus, let's look at who we are talking about when we discuss beneficiaries. Our first subject is 68 years old, no co-morbidities, low blood pressure, high-income, married, and needs a knee replacement in another year. He is going to opt for a private plan. The 87-year-old diabetic widow with COPD who relies on Social Security will opt for the traditional Medicare program, but in the end, her voucher/plan won't cover what she needs. Guess which subject is going to end up in your facility? In the latter case, maybe eventually the beneficiary can qualify for Medicaid but, sadly, the state doesn't have any more money in its block grant and can't reimburse you. Ultimately, nursing home providers will feel even more of a squeeze around case mix and suffer grave financial consequences from taking in the poor and sick.  

Price is smart enough to recognize all these problems, and I suspect as HHS Secretary would focus more on the ACA's repeal than privatizing Medicare. He also is part of an incoming administration that has had such a rocky first week, it's anyone's guess as to where the GOP is going.

But as a nursing home provider, you cannot be complacent and hope for the best. Many of you have often spoken in passionate terms about seniors' right to Medicare services, given that they have paid into it over the course of their lives. In order to keep them and nursing homes afloat, you must continue to fight for adequate reimbursement.

Follow Elizabeth Newman @TigerELN.


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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 Marty Stempniak.