The ACA Today: A Focus on Fixes

Expanding access to healthcare for all Americans – that was the laudable goal the Affordable Care Act was designed to achieve.  These days, however, the news seems filled with snag (rather than success) stories.

From website snafus and exchange errors to higher premiums and lost physicians, the nation’s attention has been drawn to a series of troubling issues.  Together with the millions who remain uninsured as well as the Hobby Lobby ruling and judicial confusion over subsidy policy, recent news stories have done more than change the ACA’s narrative – they have led to an energetic focus on fixes.

Many observers anticipate that the November elections will set the stage for ACA reform, and there is certainly much merit to that view.  But in certain circumstances, lawmakers aren’t willing to wait.

Home healthcare is one such circumstance.

When it was passed in 2010, the ACA included a provision authorizing deep cuts to the Medicare home health benefit.  The cuts were made to help pay for the ACA and, as implemented by the Centers for Medicare and Medicaid Services (CMS), total an unprecedented 14 percent reduction in Medicare home health funding between 2014-2017.

The ACA’s Medicare home health cuts went into effect on January 1 of this year and were so deep that CMS admitted they would cause “approximately 40 percent” of all home health providers nationwide to suffer net losses as a result.  Since then, Avalere Health analysts have projected that the cuts could lead to the closure or consolidation of more than 4,500 home health agencies (most of which are small businesses) and, as a result, directly impact the 1.3 million seniors they serve and the 465,000 jobs they currently support.

In light of its implications, the ACA home health cut has received considerable attention and may be on the verge of being resolved.

On July 15th, leading Members of the US House of Representatives joined together to introduce the Securing Access Via Excellence (SAVE) Medicare Home Health Act, a bill that would repeal cuts to Medicare home healthcare that were passed in 2010 to help pay for the ACA.  Importantly, the SAVE Medicare Home Health Act provides relief in a budget-neutral fashion by replacing the ACA’s 3.5 percent annual home health rebasing cut with a value-based purchasing program that will help seniors avoid hospitalization.

The bill further requires the Secretary of Health and Human Services to conduct a detailed, four-year analysis of the ACA home health rebasing cut, which was not undertaken despite the requirements of the Regulatory Flexibility Act, the President’s Executive Order 13563, and even the ACA itself.

In releasing the SAVE Medicare Home Health Act, its chief cosponsors – Reps. Greg Walden and Tom Price – and their original cosponsors and supporters made a number of astute observations.  Enactment of this bill would eliminate a threat facing the 3.5 million seniors who depend on home healthcare.  These seniors are among the most vulnerable in Medicare, as they are documented as being older, poorer, sicker and more likely to be minority, disabled and female than all other Medicare beneficiaries combined.  This legislation would provide critical relief to the rural and other communities in which these seniors live, as well as the thousands of small businesses and professional caregivers on whom they depend.  And it would accomplish all this without increasing the deficit by a single penny.

One other observation that can be made is that this bill reinforces the growing focus on fixes.

After all, when President Obama introduced the Affordable Care Act, he said Americans should never have to choose between their home and their healthcare.  Because the ACA’s Medicare home health cut gives rise to exactly that dilemma, this bill is a prime example of why today’s focus on fixes is positive – and needed.


Eric Berger is the CEO of the Partnership for Quality Home Healthcare, a coalition of the nation’s leading innovators of home healthcare dedicated to improving the integrity, quality, and efficiency of home healthcare.

Morning Consult