Bill to Delay the Employer Mandate for Certain Medicare and Medicaid Providers Introduced in the House
Legislation would provide reprieve from the ACA’s employer mandate for Medicare and Medicaid-dependent businesses - including home health agencies and hospices - until January 1, 2016
July 17, 2014 12:22 PM
Congressman Steve Daines (R-MT) recently introduced legislation that would delay the Employer Mandate provisions of the Affordable Care Act (ACA) until January 1, 2016 for businesses that offer services through Medicare and Medicaid. The bill, entitled The Ensuring Medicaid and Medicare Access to Providers Act (H.R. 5098).
Congressman Daines was urged to sponsor a bill to bring about relief from the requirements of the ACA employer mandate by the ACA Direct Care Coalition of which NAHC/National Council on Medicaid Home Care is a founding member.
The bill would exempt health care providers that receive 60 percent or more of their revenue from Medicare and Medicaid from the Affordable Care Act (ACA) employer health insurance mandate until January 1, 2016. Currently the mandate is scheduled to begin January 1, 2015 for businesses with more than 99 employees. NAHC encourages all of its members to contact their Representatives and urge them to cosponsor this legislation.
Most of the home care and hospice community is paid through the Medicare and Medicaid programs, and given recent and proposed payment cuts, H.R. 5098 would be welcome relief to home care and hospice providers that are already struggling to keep their doors open. The “burdensome employer mandate would force in-home care businesses to cut jobs or employee wages and in turn, hurt the elderly, disabled and low-income Montanans who rely on them for critical services,” Rep. Daines said on the House floor during the bill’s introduction. “The Ensuring Medicaid and Medicare Access to Providers Act protects Montanans’ access to care by exempting their health providers from [the] employer mandate and it protects healthcare workers from losing their jobs or getting their hours or their pay cut.”
Medicare and Medicaid’s reimbursement rates are considerably below comparable payments in the private market. As such, the ACA’s employer mandate would force many long-term care service provider agencies to cut jobs or reduce employee hours or wages in order to continue providing services to Medicaid or Medicare recipients, which would hinder both agencies that provide care, and more importantly, beneficiaries who receive care.
According to NAHC President Val J. Halamandaris, “this important legislation will help preserve access to home care for Medicare and Medicaid recipients while providing significant assistance to state Medicaid programs struggling to pay for home and community-based care on limited budgets.”
According to NAHC’s Legislative Priorities Document, the employer obligations under the ACA should be modified because:
“Home care businesses…have three problems that are fairly unique for employers impacted by the health care reform change. First, home care is most often paid either by government programs such as Medicaid and Medicare. These programs do not normally raise payment rates adequately or at all to cover increased costs. Second, the consumer of private pay home care is most often an elderly or disabled individual on a fixed or low income that cannot afford to absorb any price increase that would be needed to cover the cost of employee health insurance or the alternative penalty. Third, the home care workforce is employed often with widely varying weekly work hours because of changing clientele and changing client needs.”
A large coalition of groups including NAHC and its affiliate National Council on Medicaid Home Care have called on CMS to convene a stakeholder summit that brings together representatives from all stakeholder groups-consumers, providers, workers, and state Medicaid programs to develop and evaluate all of the potential options available that can result in health insurance coverage for the workers.
While CMS has listened to these concerns, no concrete action has yet to occur. Another year delay in the employer mandate would provide much needed breathing room to allow such a summit to be convened. NAHC fully recognizes that this bill does not provide relief for private pay home care or all providers of Medicaid and Medicare home care services. However, it will serve a very useful purpose for all home care providers in that it will raise awareness of the special problems that exist in home care. In that regard, it can be a stepping-stone to more comprehensive relief.