Home Care and Post Election Results

U.S. voters on Tuesday returned Barack Obama to the White House for a second term despite the struggling economy that plagued his first term. This victory in a divided nation means that the Affordable Care Act, the president’s cornerstone piece of legislation that defined his first four years in office will remain intact.

The hardscrabble presidential election cost some $6 billion, the most ever for presidential race, and the states were equally high. The Affordable Care Act (ACA), which was upheld, in part, by the U.S. Supreme Court earlier this year, will transform how Americans received health care. It was the legislation that Obama backed, some critics say, while ignoring the dramatic loss of jobs among middle-class Americans. Obama recognized that criticism as he accepted the second chance voters gave him.

In his Election Night victory speech, Obama vowed to pay more attention to job creation than he did in his first term, saying “You elected us to focus on your jobs, not ours.”

Obama won the tough re-election battle with 303 Electoral College votes and 50 percent of the popular vote, to former Massachusetts Gov. Mitt Romney’s 206 Electoral College votes and 48 percent of the popular vote.


In the Senate, Republicans were protecting only 10 seats, while Democrats were defending 23, many in narrowly divided swing states. Democrats were slated Wednesday to add two seats to their column, giving them a total of 55 seats. The seat held by Republican Sen. Olympia Snowe, is set to turn Democratic.  Angus King an Independent, is expected to caucus with Democrats. Democrat Sen. Ben Nelson’s seat also turned Republican.


On the House side, former vice presidential candidate Paul Ryan, a Wisconsin Republican will return to chair the House Budget Committee. The Democrats, as of Wednesday morning, held 192 seats with the chance of picking up another eight in races that have not yet been called. Republicans had 232 seats, and leading in two races that also has not yet been determined.

In the Balance

Romney had vowed that if elected he would repeal the ACA, which slowed the number of states that opted to begin the process of implementing health care exchange programs. Mississippi’s Phil Bryant and numerous other Republican governors have so far refused to implement the health law.

“Except for the ‘hell no, we won’t go’ governors, most of the other ones are going to take a really hard look at this the morning after,” Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University told Kaiser Health News.” And the hospital association is going to be in their face pretty quick because they want the coverage.”

Health care analysts expect some 30 million uninsured Americans to receive coverage under the ACA. Politico reported that the Obama administration is slated to release rules and regulations regarding some of the key provisions of the ACA, likely within days of the outcome. The administration has yet to release final rules regarding minimum coverage requirements for plans offered in the health care exchanges, and defining part-time versus full-time workers for penalties levied on employers that do not provide coverage options.

The home health care and hospice community has been encouraged that both parties during the campaign embraced home care in their respective platforms. Romney, however, had vowed to repeal the ACA if elected.

National Association for Home Care & Hospice President Val J. Halamandaris said that Obama’s re-election was good for seniors and the disabled seeking access to quality home health care and hospice services. “The Affordable Care Act ensures that these populations receive the home care and hospice services they require. We look forward to working with the Obama administration and both parties in Congress to make certain these options are always available. We congratulate the president on his re-election and look forward to working on our common goal – access to affordable home health care,” Halamandaris said.

Both the modernization of Medicaid and the expansion of home care were included in the Republican platform, which vowed to make home care a priority because seniors overwhelmingly wish to age at home. “We will champion the right of individual choice in senior care. We will aggressively implement programs to protect against elder abuse, and we will work to ensure that quality care is provided across the care continuum from home to nursing home to hospice, it said.” It was only the second time that the Republican Party platform had specifically endorsed the expansion of home care. The last time was 1988 when former President George H.W. Bush was elected.

The Democratic platform discussed home care through the broader and more expansive term of “home and community-based care” services which are funded through Medicaid. In his speech at the DNC Convention in August, Obama declared that “no American should ever have to spend their golden years at the mercy of insurance companies. They should retire with the care and dignity they have earned.”

What remains on the table is the impending a 2 percent cut in Medicare provider payments that could come with sequestration, the automatic budget cuts set to trigger early 2013. If not delayed or eliminated, the 2 percent cut would be implemented beginning February, 2013.

The Medicare Payment Advisory Commission, the Congressional Budget Office, and the Bowles-Simpson Deficit Reduction Plan (NAHC Report,August 8, 2012) have recommended home health and hospice payment cuts and copays to fund deficit reduction and/or to offset the cost of the physician payment fix. The home care and hospice community will need to ramp up its efforts to protect the home health and hospice benefits from payment cuts and copays.

That, experts say, is Obama’s first major challenge. He must come to some agreement with a still-partisan Congress to make certain a solution is found before those cuts take effect.


From the NAHC Report Article