House GOP Releases ACA Replacement Plan
June 24, 2016 12:58 PM
Republicans in the U.S. House of Representatives on June 22 released a plan to repeal and replace the Affordable Care Act (ACA). The plan would repeal the health exchanges as well as the employer and individual mandates under the ACA, and it would instead provide tax credits for individuals to purchase private insurance.The plan also contains proposals that would dramatically transform the Medicare and Medicaid programs as they exist today. The plan would eliminate the Medicaid expansion under the ACA, which incorporated several provisions that encouraged greater utilization of home and community-based services, and it would convert the program into either a block grant or per capita allotment option. The plan would repeal the Independent Payment Advisory Board (IPAB). However, it would also convert the Medicare program into a “premium support” model, restructure Medicare cost-sharing by limiting Medigap coverage, combine Medicare Parts A and B with a unified deductible, and institute a 20 percent uniform cost-sharing requirement for all services including home health and hospice.
While the plan does not specifically mention home and community-based care, it does contain proposals that would affect the home care and hospice community. In its Legislative Blueprint for Action, the National Association for Home Care & Hospice (NAHC) stated that any efforts to change the Medicare program through vouchers or premium support would place many seniors at risk, seriously erode support for the program, and set a dangerous precedent for other programs. While preparing the Medicare program for the changing coverage needs and demographics of the 21st century, Congress should ensure that Medicare continues to provide dependable, affordable, quality health care to older and disabled Americans. NAHC also stated that any proposals to revise the current cost sharing approaches through combined deductibles and copayments (or their equivalents) should be rejected. Cost sharing standards should incentivize high value services such as home health and hospice. Medicare beneficiaries should be able to purchase supplemental insurance to cover co-pays and deductibles without any limitation. NAHC stated that Congress should oppose any copay proposal for Medicare home health services and reject imposition of additional copayments on beneficiaries for Medicare hospice services.
With regards to Medicaid, NAHC stated that Congress should ensure that CMS properly implements the ACA’s Medicaid home care expansion and its broader coverage of home and community-based services under Medicaid.NAHC stated that Congress should reject any consideration of placing caps on Medicaid spending and increase the federal match for state Medicaid programs, thereby bolstering efforts to bring states into compliance with the Olmstead decision. Proposals for per beneficiary caps or full program federal spending caps such as block grants should be rejected by Congress.
NAHC supports modifying the employer responsibilities in the ACA to address home care specific needs. NAHC also supports abolishing IPAB.
In discussing the new plan, House Speaker Paul Ryan (R-WI) conceded that it is unlikely to become law anytime soon with President Obama in the White House. However, Speaker Ryan said the plan’s release is significant because it marks the first time that Republicans have actually released a proposal with which to replace the ACA. “Obamacare is fundamentally flawed,” Speaker Ryan said. “We're saying, don't force people to buy insurance. Make insurance companies compete for our business.”
White House Press Secretary Josh Earnest reacted to the proposal by calling it “too little, too late,” adding that it is a “political document” full of “recycled ideas” and “not worthy” of consideration. “The proposal they put forward today includes some more details, but the details they put forward today are wildly unpopular, which is why I suspect they will not receive a vote on the floor of the House of Representatives,” Earnest said.
To view the plan click here, and for a summary by the House Republicans click here.