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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

U.S. Supreme Court Issues Key Decision on Affordable Care Act

June 25, 2015 05:06 PM

The U.S. Supreme Court issued a 6-3 decision today in King v. Burwell that upheld the legality of subsidies under the Affordable Care Act (ACA) for individuals who purchase health insurance through a federal exchange. Congress, the White House, and all of America had been anxiously awaiting the ruling over the last several months. The case involved a challenge to an Internal Revenue Service rule permitting health insurance subsidies under the ACA to individuals who acquire health insurance through a state, federal, or joint state-federal health insurance exchange. The central issue was whether the language of the law permits the subsidies to individuals only if they obtain the insurance through a state exchange. Presently, 34 states do not operate a state exchange.

In a 6-3 decision written by Chief Justice Roberts, the Court held that the overall context and structure of the ACA law compelled the conclusion that the tax credit subsidy was available whether through a state or federal exchange. The Court found that Congress intended to improve access to health insurance, not make it more difficult. The Court further concluded that rejecting subsidies through federal exchanges would have had a calamitous result, the opposite of what Congress sought with the law. Chief Justice Roberts was joined by Justices Kennedy, Ginsburg, Breyer, Sotamayer, and Kagan in the majority decision.

Val J. Halamandaris, President and CEO of the National Association for Home Care & Hospice (NAHC), released the following statement on the ruling:

“Today’s ruling is the best possible result we could have reasonably expected. Any other result would have led to wholesale chaos for the health care system with people across the country being denied their benefits. The Court’s ruling essentially amounts to a ceasefire in the repeal effort.

“To be sure there are serious problems with the law that need to be addressed, with a particular focus on long-term care and more emphasis on improving chronic care management. Chronic care amounts to about 93 percent of all Medicare spending. Congress has the time and opportunity to make the necessary changes, including softening the blow of the employer mandate, which will hit many small employers hard. We will continue to urge Congress to change the employer mandate to exempt home care providers, amend the definition of full-time to 40 hours per week, provide subsidies to home care agencies, and provide tax credits to home care clients to cover the increased cost of care triggered by the employer mandate. Congress should also help states provide low-wage home care workers with health insurance through Medicaid.”  

The loss of the subsidies would have affected over 6 million individuals across 34 states without a state exchange. For several months, Republican leaders in Congress have grappled with the question of what they would do if the Court ruled that the subsidies were illegal. Many wanted to take no action as the loss of subsidies could lead to the wholesale dismantling of the ACA. Others sought a means to protect the insured individuals for a transitional period of time. In recent days, there have been indications that a consensus was developing among Republicans to tie continued, but temporary, financial support to currently insured individuals while repealing the individual and employer mandates. Congressional Democrats and the Obama Administration had offered no suggestions on what should happen if they lost the case before the Court, arguing that the Court should uphold the legality of the subsidies.

Several states have recently received approval to begin operating a state exchange that relies on the federal infrastructure. This type of hybrid state exchange would be controlled by the state but operate in a fashion very similar to a federal exchange.  With the ruling today, states will not need to institute quick changes in their operation in order to continue the subsidies to their citizens.

While the case does not directly impact home care and hospice, its indirect impact is significant. The loss of subsidies in the 34 states would have led to the effective elimination of the employer mandate in those states as the employer responsibility liabilities for penalties are linked to the subsidies. A “large” employer (50 or more FTEs) is subject to a penalty if the employer does not offer affordable and compliant health insurance to full-time employees if just one of those employees qualifies for and receives a health insurance subsidy.

NAHC surveys since 2013 show that there is a high incidence of home care employers that do not offer a qualified health insurance to full-time workers. The survey findings show that nearly 75% of Medicaid-focused home care providers and 90% of private pay, private duty home care companies are at risk of a penalty. Few state Medicaid programs have considered the problem of underfunded payment rates as insufficient to cover the costs increases related to ACA. With private pay companies, the burden of ACA falls on vulnerable elderly and disabled clients. Many of these home care companies have taken steps to avoid the liability of penalties by limiting the number of full-time employees. Less than a third of Medicare home health agencies and hospices face such a risk.

With the ruling, a significant employer penalty is now all but certain in the absence of a change in law. That change is unlikely to occur during the remainder of the Obama presidency as a veto is virtually guaranteed.  Affected home care companies must now turn to alternative measures that include offering a qualified health insurance to full time workers, modifying employment practices to control the number of “full-time” workers, seeking higher Medicaid payment rates to cover the added costs, or other actions that avoid or cope with the cost of insurance or penalty.

You can read the Court’s decision in King v. Burwell here.




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