ACA Repeal Creates More Uncertainty

Written by Briana Warsing. Posted in Volume 37, Issue 12 - March 11, 2017

For Island internist, Jack Resnick, the repeal of the ACA could spell the end of the Independence at Home Act (IHA), legislation that greatly expanded the scope of in-home services for Medicare beneficiaries.


“Repeal of the ACA is of particular importance to me and my elderly and disabled patients,” says Resnick. “The Independence at Home Act was passed along with the ACA and it enables doctors to provide the care at home for those people that would otherwise put them in hospitals or nursing homes.” Resnick had hoped his practice would benefit from the expansion of the IHA. Until now, it has been limited in scope, as a trial period.

Traditionally, many of these patients would have to be admitted to an institutional setting such as a hospital or skilled nursing facility to receive care. Under the IHA demonstration program, they became eligible to receive a full comprehensive care plan right in their home. Dr. Resnick’s practice includes 120 homebound patients who qualify as being sick enough that, if the program were extended, his patients could be served under the IHA.

Section 3024 of the Affordable Care Act directed the Centers for Medicare and Medicaid Services (CMS) to set up the IHA demonstration, and the program launched in 2012. The three-year pilot completed its first performance year in 2015. If recent lawmakers’ legislation is approved, the project will be extended to become a permanent, national Medicare program. During its first year, the program saved more than $25 million, or an average of $3,070 per beneficiary, according to the Centers for Medicare & Medicaid Services (CMS).

While Resnick was hoping this program would be extended, he isn’t sure what will happen now that Trump is in office. He states, “Washington can’t tell me what they’ll do with it.” While it’s impossible to predict the future, it appears certain that home health providers will be impacted by two of the broad objectives of the Trump White House: to relax regulations and to overhaul the nation’s health care system.

Resnick’s colleague, Island Pediatrician Dr. Katharine Grimm said, “Quite frankly I wish there was universal health care coverage like other western countries but I’m not sure that would fly politically here for a long time. I have medical students taking a child abuse elective with me from the United Kingdom, Australia and New Zealand, and contrary to the rumors we hear here, it seems to work quite well. There’s a lot of greed in this country, unfortunately, and health care is a big industry.”

Tags: Representation & Governance Briana Warsing

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