Trump presidency promises long-term care changes

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Trump's vow to repeal the ACA would be an "uphill battle," experts say
Trump's vow to repeal the ACA would be an "uphill battle," experts say

While President-elect Donald J. Trump promised on the campaign trail that he would repeal the Affordable Care Act on the first day in office, long-term care experts said Wednesday they weren't sure if he could, or whether it would lead to a full-blown systematic dismantling of coordinated care programs.

While the Republican-dominated Senate will not have enough votes for a full repeal of the Affordable Care Act, it could start removing provisions through budget reconciliation.

A full repeal of the ACA would be an “uphill battle,” said Mike Cheek, American Health Care Association senior vice president of Finance, Policy & Legal Affairs. He called wondering about how providers should handle accountable care organizations and bundled payments if the ACA were repealed “myopic and very preliminary” the day after Trump's upset win. However, if the GOP were to succeed, providers “likely would transition back to traditional fee-for-service.”

It remained unclear whether Congress would want to repeal the full act or instead focus on only specific parts, said Cynthia Morton, National Association for the Support of Long Term Care Executive Vice President.

While Trump's healthcare agenda lacked detail, House Speaker Paul Ryan (R-WI) has an extensive plan, Morton noted. Agendas can move quickly with a unified House, Senate and White House, she added. Ryan has long had a policy goal of reining in entitlement spending, she continued.

“He may find a partner in Trump on that,” Morton observed. “Where we stand today, I see repeal of Obamacare, and entitlement reform.”  

Ryan could propose Medicaid block grants for states, which would likely be a problem for long-term care, some experts believe.

“Congress can make the rules for Medicaid and then states have to operate within them,” Morton said. “The rules could be written on Medicaid reform that could favor states, but then long-term care providers have to be right there working with the governor and state to make sure funding is not reduced for patients. The fight could be in two places.”

AHCA's Cheek noted that Trump's new Secretary of Health and Human Services could direct the Center for Medicare & Medicaid Innovation to set up Medicaid Block Grant demos in certain states.

LeadingAge remains opposed to block grants, senior vice president of public policy and advocacy Cheryl Phillips, M.D., told McKnight's on Wednesday.

“In fact, we would like to see a legislative link between the quality that [the Centers for Medicare & Medicaid Services] now requires and the needed workforce and reimbursement from Medicaid to meet those quality standards,” she said.  “We are facing a real crisis when CMS adds additional standards and states are continuing to either reduce nursing home payments, delay payments for months, or fail to evaluate nursing home residents for eligibility. We do need Medicaid reform, and we need it to align with the needs for an adequate and prepared workforce at all levels of aging services.”

No matter what changes await, “taking care of the patient first is the right thing to do,” said Frank Grosso, RPh, CEO and executive director of the American Society of Consultant Pharmacists.

“As a pharmacist, I believe the process of that is key to improving outcomes and reducing rehospitalizations. If the ACA goes away, I don't think the patient-centered care is going away,” he said. “I think that's here to stay.”