The uncertainty that hangs like a cloud over Healthcare at Home providers and patients, employees and investors, seems heavier and perhaps harder to peer through than it was the last two times a moving van had recently pulled away from the White House.
In 2001, both OASIS and Home Health PPS were new and still being tested; the Bush/Cheney team seemed to have little interest in disrupting the fledgling programs. Their domestic concern in early 2001 was the cost of prescription drugs to Medicare beneficiaries but an international focus absorbed most of their attention as most cabinet meetings were about finding a way to remove Saddam Hussein. Policymakers in the executive branch mostly left Healthcare at Home to the bureaucrats at CMS.
It was already clear in early 2009 that healthcare reform was the campaign promise the Obama administration would try to fulfill first. The only question that winter was whether the so-called single-payer option would be a part of the healthcare reform bill the Democrats would push through during their short-lived majority in both houses of Congress.
This year, the future for Healthcare at Home, indeed for the entire healthcare system, is not nearly as clear, though a clear explanation of why this is so came from one of the experts speaking at last week’s Homecare 100 gathering in Amelia Island, Florida. Jason Altmire is the Senior Vice President for Public Policy and Government and Community Affairs at Florida Blue, the Anthem Blue Cross Blue Shield division there. He also served three terms in Congress as the Democratic representative from Pennsylvania's 4th Congressional District, a background that lent ample credibility when he prefaced his explanation with, "You can count the number of people in Congress who understand healthcare on one hand, and you won’t need to use all your fingers."
You have to understand that there are two parts to the Affordable Care Act. One has the features that people like, such as remaining covered on parents’ insurance until age 26, and the bans on denying coverage because of pre-existing conditions and on lifetime benefit caps. The other part has the features people do not like, such as the mandate to purchase insurance and the various requirements imposed on employers. But these two parts balance each other out. One pays for the other. If you keep only the popular features, the whole thing collapses.
Understand also the dilemma Republicans are in. It takes only 51 votes in the Senate to repeal the ACA because a proposal to undo an existing law cannot be filibustered. New laws, however, do come under filibuster rules so it takes 60 votes to pass any law Republicans may come up with to replace the ACA. That means any new healthcare legislation is going to require eight Democratic Senators to vote with Republicans. It is not likely they are going to get even one.
Altmire concluded that it will take Congress at least a year to replace the ACA and they know they do not dare repeal it before the replacement bill is ready and has enough votes to pass. “Therefore,” he advised, “plan accordingly for 2018 regulations.”
He added that one policy set in motion by the ACA has enough momentum to survive the law that generated it. “It doesn’t matter if the ACA is repealed,” he emphasized, “Value Based Purchasing is here to stay.” The set of Obama-era policies that are already effective in shifting Medicare and Medicaid payment criteria from services to outcomes, he says, have too much promise to get healthcare spending under control to be rejected out of hand by the new administration. He guarantees these successful criteria evolving in Medicare will be replicated by health insurance companies that offer commercial policies, Managed Care and Medicare Advantage.
A questioner in the Homecare 100 audience asked him about the policy observed by most Healthcare at Home providers. "We see insurance companies telling us they are grateful we are there because we cost them around $100 per day instead of the $2,000 or so per day they would otherwise pay to hospitals. Then, after thanking us, they add, 'by the way, we're only going to pay you $70, not $100.'" Altmire assured the questioner that cost is only one of over 20 metrics commercial payers consider, primary among them patient quality of life. "Payers do look only at the business case, only at the cost," he added, in a private conversation after leaving the stage.
Post acute providers, the questioner said, would like to take his word for it if not for the overwhelming evidence to the contrary.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org