With Vermont's legislature on Town Meeting Week Break, our focus was on Washington, D.C. The release of the House proposal to repeal and replace the Affordable Care Act, known as the American Health Care Act, has received extensive coverage and analysis by the media and policy experts. A detailed summary from the Kaiser Family Foundation is available
. The proposal has alarmed Vermont's leaders largely because it would replace income-based premium subsidies with aged-based, income-capped tax credits, implement per-capita Medicaid caps, and phase out federal support for Medicaid expansion. Vermont's very low uninsured rate is built on those policies.
Despite bi-partisan support for home health and hospice services, the American Health Care Act, if implemented as drafted, will have a significant impact on Vermont's home care community. While home health and hospice services demonstrably help avoid more expensive Medicaid spending on nursing home and hospital services, convincing lawmakers to invest in those services has been an uphill battle for a long time. The cost of expanding Medicaid coverage to more Vermonters has left little room for reimbursement increases. Fewer federal dollars will make the tough choices legislators must make between coverage, reimbursement and benefits that much more challenging.
The VNAs of Vermont is also concerned about the repeal of enhanced federal matching dollars for what's known as the Community First Choice Option, effective January 1, 2020.
This program helps states to move long-term care services out of nursing homes and into the home setting without applying for a federal waiver by funding personal care services. Vermont has a long-standing waiver in place (the Choices for Care program) so the impact is indirect, but it signals a troubling step backward.
The VNAs of Vermont will continue to watch these developments closely in the weeks ahead.