The AHCA plan
The AHCA plan intends to partially repeal the Patient Protection and Affordable Care Act (ACA) by introducing reforms to the Medicaid program, among other health-care-related amendments (Bahr, Spiro & Calsyn, 2017). Medicaid is a health-care program in the United States that covers one in every five Americans, including low-income children and adults, the elderly, and those with disabilities.
Restructuring Medicaid
Medicaid is the principal payer for nursing home care, especially for the elderly and persons with disabilities. The AHCA focuses on fundamentally revamping the Medicaid program by instituting per-capita restrictions on federal spending on Medicaid enrollment. The restructure aims at lowering federal spending on health care services over time by lowering Medicaid spending as well as the coverage that relates to the current law, ACA. It is estimated that the implementation of the restructure will realize a 15 million reduction of Medicaid enrollees by 2026 (Bahr, Spiro & Calsyn, 2017). AHCA seeks to achieve the objective through such measures as reducing the funding to the states that gained coverage through the Medicaid expansion that is detailed under the ACA, eliminating coverage mandates, and lowering the inflation index used in the computation of the per-enrollee payments to the states.
Reasons as to why the Bill is not effective for the Elderly and People with Disabilities
Although the AHCA bill would bring about several benefits, including saving on the cost of providing health care for the federal government, the bill is not effective for the elderly and people living with disabilities, who heavily rely on the Medicaid funding for their health care needs. The elderly and people with disabilities have more health needs compared to other populations, which leads to their heavier Medicaid spending (Bahr, Spiro & Calsyn, 2017). The elderly population is largely affected by chronic diseases, which are costly to manage. On the other hand, people with disabilities require special programs to support their basic survival, which is facilitated through Medicaid funding. For instance, the Medicaid program is responsible for paying for the services and the equipment required in the education of learners with disabilities.
Impact on Long-term Care
Approximately twelve million disabled and elderly Americans depend on long-term care for their daily activities, ranging from cooking, eating, housekeeping, to bathing (Musumeci & Foutz, 2017). Hence, adopting the per-capita cap as suggested by the bill would hurt the elderly and disabled population, who are heavily reliant on the Medicaid support and long-term services. The majority of the services that Medicaid provides to the population cannot be accessed through private insurance schemes, and they are also too expensive for the population given that the majority earns low incomes. Medicaid covers for such services as attendant and personal care services for the elderly and disabled, rehabilitative services that equip people with disabilities with skills for independent living, community-based mental-health services, and supportive housing services, which are costly to finance out-of-pocket.
Therefore, with the implementation of the bill, the elderly and the disabled will be denied access to quality health care services, since the majority cannot afford to finance the long-term care that they need for their survival. The cuts proposed in the bill on the Medicaid program benefits the wealthier individuals and the healthcare industry, who would receive a huge tax break. However, the bill, which would lower Medicaid funding by approximately $880 billion, would jeopardize the essential care for the approximately 17 million elderly persons and people with disabilities, who cannot afford to finance the required care services (Musumeci & Foutz, 2017). Additionally, the capping of the Medicaid program would subsequently affect the Medicare program, since reducing access to the home care services offered to the elderly and the disabled to manage complex health conditions would translate to more hospital visits for the eligible individuals, whereby the costs incurred are borne by Medicare.
The Section of the Bill that requires Change
The specific section of the AHCA bill that I would like to change is 'Subtitle C- Per Capita Allotment for Medical Assistance; Sec. 121'.The section of the bill details the required limits on the federal funding for the state Medicaid programs starting in the financial year 2020 (Congress.gov., 2017). The section of the bill has outlined the required spending caps for each state, which were determined using each state's medical assistance expenditures on the program's enrollees, including the elderly, and the blind and disabled among others. I would like the section to be changed to allow for the continued access to the long-term care for the elderly and the disabled, who are not in a position to effectively finance the care services since they are costly and the population largely comprises of low-income earners. Moreover, changing the section is particularly crucial for the population, which depends on such services as specialized therapies, skilled nursing, and personal-attendant care, since the implementation of the per-capita caps could lead to the population losing access to the services, which are vital in ensuring that the population lives independently and remains at home.
Change Agent for the Bill Change
The champion for the bill change will be the American Public Health Association (APHA), an advocacy group that focuses on promoting policies that seek to increase public access to health services as well as making the public healthier (American Public Health Association, 2017). APHA influences the federal policies that pertain to public health by speaking out for the public health issues and policies, supported by research and science, to promote equity in the health status of the public. The advocacy group is the most appropriate change agent in this case since it combines over 40 years of experience in influencing federal policy with the aim of improving the public's health; indicating that they are well-equipped to manage social justice issues that relate to the health of the elderly and the disabled (Satariano et al., 2012). Further, the advocacy group has an aging and public health section, whose key objective is to promote the well-being and the health of individuals as they age, through improving their quality of life, health, financial security, and functioning.
References
American Public Health Association. (2017). Aging & Public Health. Apha.org. Retrieved 8 September 2017, from https://www.apha.org/apha-communities/member-sections/aging-and-public-health
Bahr, D., Spiro, T., & Calsyn, M. (2017). Reforms to Help Meet the Growing Demand for Long-Term Care Services - Center for American Progress. Center for American Progress. Retrieved 8 September 2017, from https://www.americanprogress.org/issues/healthcare/reports/2014/10/31/100040/reforms-to-help-meet-the-growing-demand-for-long-term-care-services/
Congress.gov. (2017). H.R.1628 - 115th Congress (2017-2018): American Health Care Act of 2017. Congress.gov. Retrieved 8 September 2017, from https://www.congress.gov/bill/115th-congress/house-bill/1628
Musumeci, M., & Foutz, J. (2017). Medicaid Restructuring Under the American Health Care Act and Nonelderly Adults with Disabilities. The Henry J. Kaiser Family Foundation. Retrieved 8 September 2017, from http://www.kff.org/medicaid/issue-brief/medicaid-restructuring-under-the-american-health-care-act-and-nonelderly-adults-with-disabilities/
Satariano, W. A., Guralnik, J. M., Jackson, R. J., Marottoli, R. A., Phelan, E. A., & Prohaska, T. R. (2012). Mobility and aging: new directions for public health action. American Journal of Public Health, 102(8), 1508-1515.
