The ACA and Medicaid

After months of Republican vows and political rhetoric on repealing and replacing the Affordable Care Act (ACA), the GOP introduced its proposed bill in March amid a flurry of media coverage and association outcry. In a letter to Congressional leaders, more than 90 associations and agencies—including LeadingAge, the Gerontological Society of America, AARP, the American Society of Consultant Pharmacists and the National Association of State Long-Term Care Ombudsman Programs—blasted the bill as a stake in the heart of Medicaid.

As proposed, the American Health Care Act outlined sweeping changes to the foundations of Medicaid, including placing a cap on the funding provided to states though block grants or per-capita limits. The action would have caused “radical structure changes” to the Medicaid system, especially for dual-eligibles, the association letter stated. Placing so much burden for Medicaid on the states could erase the only safety net available for millions of Americans who cannot afford the services and supports they need.

Then, in dramatic fashion, Speaker Paul Ryan pulled the bill from the House floor minutes before the vote was to take place. Now, Republicans and Democrats will have the opportunity to take a step back, breathe and think about how to fix the ACA without throwing the baby out with the bath water.

Support for the repeal and replace movement has come primarily from the removal of taxes and penalties under the employer and individual insurance mandates and the policy requirements under the health insurance marketplace, which the insurance industry and the GOP say are sending the law into “a death spiral.”

While parts of the repeal bill had bipartisan support, other parts received cross-party resistance. The refundable tax credits proposed by the bill angered conservatives, while states that adopted Medicaid expansion cried foul over the proposal to phase out Medicaid expansion in 2020. Others tallied the horrifying numbers of older adults—perhaps 6 million—who would be impacted by the proposed cuts in Medicaid, especially low-income, rural or disabled adults.

Even the pundits agree many other parts of the original ACA were decent ideas and will probably remain in place, regardless of what the next repeal and replace bill looks like. That means value-based purchasing, mandates for quality improvement, Accountable Care Organization (ACO) programs and everything currently tied to the Medicare mandates, probably won’t be going away anytime soon.

Meanwhile, Congressional committees will begin the next version of a repeal and replace bill, striving to gain the majority votes the legislation will eventually need to pass the tight margins in the Senate. For now, we will have to wait for bill No. 2 (or 3, or 4) to learn the real details on how many people the bill will cover—and how much it will cost.

Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.