NIC Notes

Insights in Seniors Housing & Care

By: Liz Liberman  |  January 27, 2017

ACA Repeal and the Impact on Long-Term Care

Economic Trends  |  Regulatory Environment  |  Skilled Nursing

Shortly after the U.S. presidential election, the Senate and House began the formal process of repealing the Affordable Care Act (ACA). Then, within hours of his inauguration, President Donald Trump signed an executive order instructing all federal agencies "to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market."

Just as the ACA acted as a major reform of the health care payment and delivery system, repealing the ACA will also have a major impact on health care providers, consumers, and the companies in between, such as pharmaceutical manufacturers and, of course, insurance companies. But how will the repeal of the ACA directly affect providers in the seniors housing and care space?

Fee-for-Service Medicare Will Likely Continue to Transition to Value-Based Care

While the ACA included some provisions that pushed the health care system in the direction of value-based payments, the Medicare Access and CHIP Reauthorization Act (MACRA) is the major impetus for the move from fee-for-service in Medicare. Because MACRA was so popular—passing by huge majorities in the House and Senate—changes to that law are highly unlikely. In fact, as Modern Healthcare reported, Kaiser Permanente CEO Bernard Tyson agrees that value-based care will endure under the Trump administration, and the company will continue to expand its brand of value-based care delivery in new markets. However, the executive order signed by President Trump on Inauguration Day could slow down the transition to value-based payment and care delivery and affect Comprehensive Care for Joint Replacement (CJR) and other bundled payment programs that grew out of the ACA.

ACA Repeal Could Impact Long-Term Care Providers

The ACA led to a number of changes for nursing homes and long-term care in general. For example, the ACA gave the Centers for Medicare & Medicaid Services (CMS) the authority to collect data from nursing homes on an expanded list of quality measures. The ACA also made it easier for states to use federal Medicaid dollars for long-term care support systems and services, including expanding options for home- and-community-based services for people who are eligible for a nursing home but can alternatively reside at home with the appropriate support systems in place. Until more details emerge, we will not know how these changes will be affected by the prospective repeal and replacement for the ACA, or how CMS will enforce the executive order.

Seniors Advocates Voice Their Concerns

Recently, several groups have called on lawmakers to keep the needs of the nation's elders in mind when crafting new health care policies:

  • The Leadership Council of Aging Organizations, which represents over 70 organizations, including AARP and LeadingAge, sent President Trump a letter that outlined the 12 provisions in the ACA that impact seniors and urged the President to not eliminate those provisions in his repeal-and-replace plan.
  • According to Provider Magazine, the American Health Care Association hopes to leverage the transition of power to President Trump to repeal the requirements for participation rule that includes the arbitration ban.
  • The Coalition for Medicare Choices, which works closely with America's Health Insurance Plans that represents its nearly 1,300 member companies, is launching a multi-million-dollar advertising campaign to raise awareness about Medicare Advantage.
  • The American Geriatrics Society published two articles in the organization's journal detailing its own priorities for the new administration.

With all of these voices and competing priorities, lawmakers and policy drafters have a challenging job ahead of them. Until details emerge of the next phase of healthcare reform, most will be left guessing how seniors’ healthcare will be affected and as a result, will likely default to a business as usual strategy (BAU).

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About Liz Liberman

Healthcare Analyst Liz Liberman provides policy, regulatory, and healthcare perspective to the dynamic environment surrounding the seniors housing and care market. She comes to NIC from the Department of Defense, where she served as a contractor in Acquisition policy, implementing statutes, executive orders, and updates into the Federal Acquisition Regulation (FAR) and Defense Federal Acquisition Regulation Supplement (DFARS). She also served as a health policy analyst for Bulletin Intelligence, where she crafted daily briefings for government agencies and trade associations in the healthcare field. Liz earned degrees from The George Washington University (B.S.) and George Mason University (M.S.), and is a member of the Junior League of Washington.

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