Health Reform Hits The House

The U.S. House of Representatives soon will vote on the Affordable Health Care for America Act (H.R. 3962), a landmark bill ensuring that millions of Americans, will have access to health care coverage they have never had before.

Efforts to make this coverage a reality go back almost a hundred years, through the presidencies of Teddy Roosevelt, Harry Truman, Lyndon Johnson, Richard Nixon and Bill Clinton.

Now it’s down to one measure coming to a vote in the House — possibly in the next week — with a slightly different measure to be taken up by the Senate soon thereafter. Once the Senate and House have taken their initial passes at the legislation, a conference committee will determine which provisions will be in the final version to be sent to the president.

In 2003, AAHSA board members considered the issue of access to health care insurance and gave it a high priority. Earlier this year, the board again reviewed the issue of health care reform and decided that “health care reform is essential now, including long-term services and supports.”

The AAHSA board applied the same criteria for evaluating health care reform proposals generally that had earlier been developed for screening long-term services and supports financing proposals. In both cases, the board called for a national solution to a national problem, as universal as possible, affordable for individuals, fiscally responsible for government, giving consumers choice and control, supporting family caregivers and investing in both quality and talent.

Our initial evaluation of H.R. 3962 indicates that it conforms with many of the principles that our board articulated for health care reform in general, and long-term services and supports in particular. We are examining the legislation’s potential impact through four primary lenses:

• On our residents, clients and their families?
• On our members as providers?
• On our members as employers?
• On those who work in our member organizations?

Impact on Medicare Beneficiaries

We have heard from many members that their residents are extremely anxious about health care reform’s impact on their Medicare benefits. You can reassure them that the House bill makes no changes to their benefits or premiums, and that the program will continue to operate as it does now.

In fact, for beneficiaries, the bill includes several Medicare improvements:

• Filling the so-called “doughnut hole” in Medicare Part D prescription drug coverage.
• Medical home provisions to ensure better coordination of services.
• Improved coverage of preventive care.

CLASS Act Provisions

One of the bill’s most far-reaching effects will be its impact on the future of aging services through the inclusion of the Community Living Assistance Services and Supports (CLASS) provisions. This plan for a new structure to finance long-term services and supports closely tracks the recommendations of our own member-led Long-Term Services and Supports Financing Cabinet.

Looking ahead, our cabinet forecast that the Medicaid program would become unsustainable as the default coverage for the services we provide. We are seeing the truth of that prediction this year as states cut back on provider reimbursements and on coverage of long-term services and supports provided in home and community-based settings.

Both consumers and providers need a more responsible and sustainable source of financing for the services that growing numbers of Americans will need as they age. The inclusion of CLASS provisions in H.R. 3962 is a direct result of this year’s extraordinary grassroots advocacy in which many of you participated.

Last year, no one on Capitol Hill was willing to say “health care reform” and “long-term services and supports” in the same sentence. Our members not only contacted legislators yourselves, but  they involved  their boards, residents, staff and families as well. The fact that we have come so far with CLASS is largely due to their efforts, and we thank them.

Medicare and Medicaid

In addition to the CLASS provisions, the House bill contains a number of improvements in Medicare and Medicaid. It extends the economic stimulus package’s increase in federal Medicaid matching funds for another six months, through the end of June, 2011. For nursing homes, the legislation contains a new $6 billion in federal Medicaid funds to mitigate under-reimbursement for homes that meet quality criteria. The bill mandates a study of the adequacy of Medicaid reimbursement. It also addresses the flaw in the Medicare prospective payment system that under-reimburses for the care of medically complex residents, many of whom receive their care in AAHSA-member facilities. It renews the caps exceptions process for Medicare coverage of out-patient therapy.

For home care, the bill calls for an evaluation of Medicare margins and would delay hospice reimbursement cuts for another year. The legislation addresses the high cost of health insurance that many of you experience as small businesses by establishing health exchanges with affordable policies and guaranteed benefits. The bill also makes a number of improvements to the federal nurse education program, including increased loan repayment benefits and the removal of caps on awards for nurses pursuing advanced degrees.

The reality is that no legislation will ever provide everything we want and nothing we don’t. Two provisions of H.R. 3926 in particular concern us. One would eliminate the 2010 Medicare payment update for nursing homes and home health care providers as of Jan. 1, 2010.

The other would increase civil monetary penalties imposed for survey deficiencies. The rules under which the legislation will be considered on the House floor do not allow for any revisions or removal of these provisions. The Senate is taking a different approach on both of these issues in the legislation it is drafting, and we are working to make sure that the Senate provisions prevail when health care reform reaches the House-Senate conference committee.

You have two opportunities to learn more about the health reform bills in the next few days:

1. Through our participation in the Seniors to Seniors coalition, residents and clients of AAHSA members have an unprecedented opportunity to join other seniors on a White House Conference Call with U.S. Health and Human Services Secretary Kathleen Sebelius to ask questions and learn about how health care reform will impact seniors’ access to physicians, Medicare Part D drug plans, and most important, long-term services and supports. The call is Thursday, Nov. 5, at 5:15 p.m. Eastern. Phone lines are limited, so advance registration is required. Anyone who would like to participate should RSVP.

2. Attend our 2009 Annual Meeting next week in Chicago. There will be numerous discussions in plenary sessions and education workshops to learn and understand health care reform. Our speakers will include Assistant Secretary for Aging Kathleen Greenlee. We hope you will come, gain more information, and share your feedback with us so we in turn can bring it back to Washington to work with members of Congress as they make the final decisions on health care reform legislation.

This is a rare and unprecedented time in the life of our country. We thank the members of Congress for what they have done so far, but we also will continue to work with them toward final health care reform legislation that combines the strengths of measures developed in both the House and Senate.

Stay tuned and stay involved.