Five Ways the Graham-Cassidy Health Care Bill May Affect OT and Your Clients

AOTA Staff

The Senate has revitalized efforts to restructure the Medicaid program and replace the Affordable Care Act. This legislation could affect more than 80 million Americans, by some estimates. The American Occupational Therapy Association has grave concerns about the Graham-Cassidy Health Care bill and urges you to contact your Senators today. Here are five ways the bill may affect you and your clients.

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1) Will insurance and Medicaid cover OT?

The Essential Health Benefits descriptions for individual and small group insurance policies will be set by states. Rehabilitation and habilitation may not make the cut, and OT may not be in the packages. Medicaid occupational therapy benefits may be cut for children and adults because of the $53 billion decline proposed for 2020 to 2026. This affects OT practitioners of course but more importantly, clients with critical needs may no longer have access. The National Association of Medicaid Directors (pdf) says the bill would “fail to deliver on our collective goal of an improved health care system."

2) What will happen to hospitals? Do you work in an acute or rehabilitation hospital?

Hospitals, especially in rural areas and those that serve primarily Medicaid patients, will lose significantly by overall cuts to Medicaid. Of particular note is the scaling back, from 3 months to 2, of retroactive Medicaid eligibility for some Medicaid enrollees. Retroactivity eligibility, which has been in law since 1965, means a hospital can get reimbursed for emergency, acute, or rehabilitation care for an uninsured person before Medicaid approves them. And more people are likely to become uninsured. The American Hospital Association says, “This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term."

3) Will children be affected? Do you work in schools?

In schools and early intervention alone, Medicaid supports $4 billion in IDEA-mandated services every year. Medicaid cuts will most certainly affect these services. Pediatric OTs are likely to see significant cuts in coverage, more restrictions, and reduced payment for Medicaid services wherever they are provided because states will be faced with finding more state money or significantly cutting services. Other children’s services may be limited. And with no option for subsidies for health insurance, some families may fall through the cracks and have no coverage at all.

4) Are you concerned about discrimination?

Under the bill, insurance companies will be allowed to charge higher rates for individuals with pre-existing conditions, including children, dependent upon the choices each state makes. Rates for older individuals can also be up to five times higher than for younger individuals.

5) What will happen to the insurance market? What will happen to your own health insurance?

If you purchase through the ACA marketplaces, federal subsidies and support for those marketplaces will disappear in 2020. States may replace the marketplaces or provide some other option for lower-cost insurance, but there is no requirement for them to do so. If your own insurance covers OT now, it may not in future years as states change insurance regulations. The Blue Cross Blue Shield Association predicts that the Graham-Cassidy bill “would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”

It is important that your Legislators hear from you, their constituents. Protect the profession. Protect the people we serve. 

Act today!

For more information on the bill:

AOTA blog: Health Care Reform Still in Flux

Health Affairs Blog: Graham-Cassidy: A Closer Look at the Medicaid Provisions

Essential Health Benefits: What Marketplace Health Insurance Plans Cover

Kaiser Family Foundation: State-by-State Estimates of Changes in Federal Spending on Health Care Under the Graham-Cassidy Bill

Kaiser Family Foundation: Graham-Cassidy-Heller-Johnson Plan to Replace ACA Funding With a New Block Grant and Cap Medicaid Would Decrease Federal Funding for States