Keeping Score

The Congressional Budget Office has thrown in the towel on trying to score the Affordable Care Act.

Originally projecting that the ACA would reduce the federal deficit by $120 billion over a decade, the CBO quietly conceded in the footnote of a June report to Congress that it is unable to provide the federal government and the American people with a projection on how the sweeping healthcare law will impact the nation’s bottom line.  Further, CBO indicated that it will no longer even evaluate Obamacare’s fiscal implications because of all the changes made during the law’s implementation.

These are surely trying days for actuaries and analysts, but they can console themselves with this fact: even if the CBO can’t keep the ACA’s score, Americans can – and are.

Nowhere is this more evident than in the homes of 3.5 million Medicare beneficiaries.  The Medicare home health benefit, on which those 3.5 million seniors and disabled Americans depend, is being subjected to a 14 percent cut in funding due to the imposition of a four-year, 3.5 percent per year “rebasing adjustment” implemented by former Secretary Kathleen Sebelius using discretionary authority granted her in the Affordable Care Act.

As the Centers for Medicare and Medicaid Services (CMS) itself noted, this cut will cause “approximately 40 percent” of all home health providers to operate at a loss by 2017.  Just as striking, the agency bankruptcies and closures that will inevitably result have been projected by Avalere Health to put access to home health at risk for more than 1.3 million seniors.

Just who are these seniors?  Medicare data analyzed by Avalere Health reveal that home health patients are among the most vulnerable in the Medicare program.  Specifically, Medicare home health beneficiaries are older, sicker, and poorer than all other beneficiaries in the Medicare program – combined.  In addition, Medicare home health beneficiaries are more likely to be women, disabled, and members of ethnic or racial minority populations than all other Medicare beneficiaries.

Without access to medical services delivered in their homes, many of these homebound seniors will have to be placed in institutional facilities, taking them away from their families and imposing higher out-of-pocket costs on them and higher medical costs on taxpayers.  And these seniors are keeping score.

So are women.  Avalere estimates that an extraordinary 90 percent of the professionals who are commonly employed by home health agencies are women.  As a result, job losses stemming from the peril facing all home health agencies – and particularly the 465,000 home healthcare jobs supported by the “approximately 40 percent” of agencies facing net loss – will disproportionately impact women in the healthcare workforce.

Seniors and female professionals from coast to coast know this all too well.  For example, the Visiting Nurse Service of New York – the largest nonprofit home health agency in the country – announced in April it was eliminating 775 positions due to Medicare and Medicaid cuts.

That’s 775 more score-keepers.  And there will certainly be more, given the unprecedented severity of this ACA-based cut and the incomplete analysis on which it was based.

Fortunately, leading lawmakers on both sides of the political aisle are working to preserve access to the clinically advanced, cost-effective and patient-preferred home health services on which their most vulnerable constituent depend.  This, too, is well known to their home health constituents.

As a result, CBO may no longer be scoring the ACA, but that doesn’t mean others aren’t keeping score.  Quite the contrary.


Eric Berger is CEO of the Partnership for Quality Home Health, a coalition of community- and hospital-based home healthcare agencies dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation’s seniors.


Morning Consult