A few months ago, Lawrence Lopardo’s No. 1 concern was uncertainty about the future, or lack thereof, of the Affordable Care Act.
Today, the top concern for Lopardo, executive vice president and general counsel at elder-care provider Avamere Health Services, is the future of Medicaid under the American Health Care Act, the U.S. House of Representatives’ version of the Affordable Care Act change bill. Under the bill, passed by the House May 4, the future of Medicaid is a little bleak—or at least $880 billion less funded.
As the Senate works behind closed doors to rewrite the bill from scratch in the hopes of getting it to a vote before its weeklong July 4 recess, uncertainty is still at the top of Lopardo’s list of concerns.
Avamere Health, headquartered in Wilsonville, Oregon, is a group of independent companies that provide skilled nursing, assisted living, therapy, home health and hospice to senior citizens in several Western states. Lopardo spoke with Corporate Counsel about some of the senior health care issues implicated in the reform efforts and the effects of the uncertainty surrounding the overhaul.
The AHCA changes Medicaid’s long-standing financing structure from an entitlement program to a grant program or per capita cap, a proposal with serious possible consequences for the nation’s elderly. Medicaid payments, for example, can account for 50% to 70% of a nursing home’s reimbursements, Lopardo said.
Such a proposal, he added, will pit all of a particular state’s Medicaid beneficiaries, including seniors, against each other in a “50-state battle for their fair share” of funding, which states may cut as they adjust to the substantial federal funding reductions.
A solution, Lopardo said, is to separate senior care from the other types of care provided under Medicaid, an idea floated here and there by some Republican governors but not addressed in the pending federal reform bill. “Certainly it’s something we need, but the early proposals don’t discuss that, so where does that leave the elderly?” he said.