Providers incited over Medicaid provisions in Senate health bill

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“It’s every bit as bad as the House bill, in some ways even worse,” says Senate Minority Leader Charles Schumer (D-NY).
“It’s every bit as bad as the House bill, in some ways even worse,” says Senate Minority Leader Charles Schumer (D-NY).

Senate Republicans emerged Thursday to release details of their health reform bill that would repeal and replace the Affordable Care Act, and providers made no secret out of their displeasure.

The Senate proposal mirrors Obamacare in some ways and mimics the House's disparaged American Health Care Act in others, analysts said. That's enough to elicit criticism even from various factions within the Republican party.

And, of course, long-term care providers. Medicaid provisions figure to severely curtail funding to the sector.

“LeadingAge continues to strongly oppose the fundamental changes to the Medicaid program made by both the House and Senate legislation repealing the Affordable Care Act,” said Katie Smith Sloan, LeadingAge president and CEO, in a statement.

“Medicaid is not just for poor people. It is the way middle-class families pay for long-term services and supports,” she continued. “The Senate bill actually cuts funding for Medicaid even more deeply than the House bill in the long run due to a lower annual growth rate. These cuts and caps on Medicaid have the potential to hurt every American family.”

Under the Senate plan, governors could impose work requirements in the program, phase out Medicaid expansion starting in 2021 over three years, and restructure financing with the option for either lump-sum grants or per-enrollee spending ceilings. The bill would shift costs to the states and put the frail at risk, opponents said.

“It's every bit as bad as the House bill, in some ways even worse,” Senate Minority Leader Charles Schumer (D-NY) said. He called it “a wolf in sheep's clothing, only this wolf's teeth are even sharper than the House's.”

“This is a step to eradicating [Medicaid],” he said.

“It's not good,” agreed Cynthia Morton, executive vice president for the National Association for the Support of Long-Term Care, in an interview with McKnight's. “No matter how we try to protect the funding for our very precious, vulnerable population, [Medicaid] funding will decrease to the states. The draft fortunately does keep the update factor plus 1% for the aged, blind, disabled group, like the House version, but it ends in 2024 [while the House version doesn't].” 

Morton said that one “potentially good thing” is that the Senate bill allows states to pick eight quarters of data from 2014 to mid-2017 to set its base payment year, while the House bill limits it to 2016.

She believes the Senate bill differs by allowing states to receive bonus payments for cost reductions and quality achievements. The Senate proposal, however, also would phase down providers' ability to benefit from state bed taxes, dropping the ceiling from 6% to 5%, which could mean millions of dollars out of the funding stream.

Mark Parkinson, president and CEO of the American Health Care Association, also had strong words for the Senate proposal.

"Today's Medicaid system already underfunds nursing center care by $7 billion annually. Skilled nursing centers across the country operate on razor thin margins. The additional cuts proposed in the Senate bill released today —including a reduction in provider assessments that alone will result in billions of dollars less to skilled nursing care each year — are deeply distressing," Parkinson said. 

“The bill proposes to take hundreds of billions of Medicaid dollars away from the aged and disabled. Most of the one million people who reside in nursing centers rely on Medicaid, as well as tens of thousands of seniors in America's assisted living communities. Our seniors deserve better than an unstable and underfunded safety net."

A flurry of activity is expected over the next week, with the Congressional Budget Office soon to release a cost analysis. GOP leaders hope to bring the bill for a full vote by Friday, June 30, after which lawmakers leave town for the July 4 break.