The American Health Care Act, or AHCA, has undergone a series of edits by he Senate that were only officially released yesterday, June 23, 2017. Senate majority leader Mitch McConnell has slated the revised bill for a vote next week, sparking intense debate and outrage from the other side of the political spectrum. Proponents say the bill will reduce healthcare costs and lower the national deficit over a period of ten years. Opponents of the bill say some 23 million Americans will lose healthcare coverage under the new law. What is certain is that the new law would change many things in healthcare, potentially even in hospice. This leaves us with many questions, most important of which (for us) being: would the AHCA change how hospice is paid for?
AHCA proposes deep cuts to Medicaid.
For the vast majority of patients who enter hospice, their care is currently covered by Medicare Part A. This fortunately is not a program that is subject to much change under the new healthcare law as written. However, the AHCA does propose deep cuts to Medicaid, which serves one in five Americans, and is a vital program for nearly two thirds of residents in nursing homes. This program is also a vital program for younger hospice patients who do not yet qualify for Medicare Part A and whose health insurance does not fully cover the cost of their care.
Who will be affected by the AHCA?
Currently, 5% of hospice patients rely on the Affordable Care Act’s Medicaid expansion to pay for hospice. Around 7% of patients cover additional costs through private insurance. These are the only populations who could be affected by the AHCA. It is important to note that there is a great deal of uncertainty about how exactly the AHCA will affect these populations. What we do know is that the bill does not mention the words “hospice” or “palliative” and does not directly target end of life care for any major changes.
Explains Dr. Noam Stern in an article penned for the Hospice Action Network in regards to the AHCA, “The vast majority of hospice patients would be unaffected by the AHCA. Patients covered by Medicaid and private insurance might be affected, but it’s too early to tell how these changes would affect hospice operations in the long run.”
Patient advocacy groups discuss AHCA concerns as Senate vote looms.
Patient advocacy groups, such as the American Cancer Society Action Network, AARP, American Diabetes Association, American Heart Association, American Hospital Association, American Medical Association, Federation of American Hospitals, March of Dimes, among others, met in Reno this week to discuss the AHCA and its impact on patient care. Most concerns centered around health insurance coverage, whether or not pre-existing conditions will continue to be covered, and a myriad of other possible changes under the new law.
One attendee, an experienced hospice nurse named Sharon Brown, directly addressed the issue of hospice patients whose care coverage may change under the AHCA. “When I first became a hospice nurse 10 years ago, people were losing their homes. People had to cash out their 401Ks to be able to pay for their medical care because they had either maxed out on their lifetime caps or had preexisting conditions. So they couldn’t get health insurance, let alone afford it.”
Too early to tell.
Despite concerns over the new healthcare law, the big takeaway from all the media coverage and commentary is that for most of what is proposed it is still too early to fully understand how patients will be affected. From the original framework, and the edits made by the Senate, we know that the vast majority of patients entering hospice will not be affected. Hospices themselves will not likely be greatly affected, if at all. What remains to be seen is what will happen to those who rely on the Medicaid expansion and private insurance to cover costs.