What the Election Results Could Mean for Long-Term Care in 2021

Some likely scenarios to keep on your radar.

post election LTPAC changesOn December 14, the Electoral College met and affirmed that Joe Biden won the presidential election. While some GOP lawmakers are waiting to weigh in until January 6 when Congress votes whether to accept or reject the Electoral College votes, leaders like Senate Majority Leader Mitch McConnell are acknowledging the win and congratulating President-elect Biden now.

Meanwhile, the majority control of the Senate will come down to two runoff elections in Georgia on January 5. The Republican Party currently maintains a narrow lead, but it’s anyone’s guess as to how things will turn out just days before Biden takes the oath of office.

So even at this point, as we try to grasp what likely lies ahead for health care policy, potential reform, and regulatory updates, a lot remains uncertain. With that said, a few things are worth thinking about now so you and the rest of your team can be as proactive as possible with your New Year goals, plans, and strategies.

The Affordable Care Act (ACA)

With Biden as president, it is very likely that we will see a reinforcement of the Affordable Care Act and the insurance options it offers to citizens who cannot obtain coverage via their employers. In fact, his transition team is currently contemplating steps they can take to reinvigorate it as soon as Biden is in office, such as reopening ACA insurance marketplaces outside the standard sign-up cycle. Long-term care patients who are not yet eligible for Medicare could, in turn, experience improved access to affordable insurance options. Meanwhile, regulatory reporting will continue, with a chance of less reporting in 2022 based on current rulemaking.

The Expansion of Medicare

During his campaign, President-elect Biden and the Democratic Platform proposed reducing the Medicare eligibility age from 65 to 60. Such a change would allow eligible individuals to choose between continuing under their employer-provided plan or enrolling in Medicare when they reach the age of 60. The cost of this change would be financed by general revenues as opposed to the Medicare Trust Fund. Meanwhile, the Democratic Platform also called for an expansion of Medicare to include dental, vision, and hearing benefits. Should these changes occur, they may impact the reporting of quality measures in long-term care as more patients become eligible for Medicare coverage.

Prescription Drug Cost Reductions

Biden’s platform also proposed the repeal of the law that prevents the Medicare program from negotiating drug prices with drug companies. What’s more, it would ideally establish an independent board with the purpose of setting reasonable drug prices based on the average price in other countries and applying these prices in Medicare coverage. Should these changes occur, they could impact both reporting and preferred choices of drugs in long-term care, depending on reimbursement and insurance benefits provided.

A New Public Option

While this change would likely take longer than a year to come to fruition, Biden and the Democratic Platform campaigned on expanding the Affordable Care Act to create a new public option that would allow a portion of citizens to enroll in a Medicare-type insurance program. This addition, along with the shift of the Medicare eligibility age, will rely heavily on the outcome of the Senate elections in January.  But if such a plan is enacted, it could expand coverage and your quality reporting requirements in long-term care.

Are there any other potential changes you’re keeping a close eye on for the sake of your practice and your patients? Share your thoughts with us in the comments below.

2 thoughts on “What the Election Results Could Mean for Long-Term Care in 2021

  1. I am against the proposed plan. Too much regulations and quality reporting on long term care. It only increases more dependency on government controlled healthcare. This will eventually lead to universal health care which I think most Americans does not want.

  2. I would love to see increased reimbursement for the SNF staff; I think they are vastly underpaid while the care requirements for the residents they see in the facility have expanded. Not only are they caring for long-term and post-acute care individuals, they are seeing an increase in residents with mental health problems that are impacted by surgery, illness or dementia. They are having to deal with residents with substance abuse problems. The rules have changed, but state and federal guidelines expect these facilities to follow older rules and guidelines that really obstruct their ability to provide reasonable and safe care because “the patient’s rights out-weigh their treatment needs”. The penalties are still in place and don’t seem to reflect the changes that have occurred. These need to be re-evaluated and re-vamped. Facility staff need increased training as well. Working in a SNF is no longer a “mindless” job of passing pills and being family to the residents. We also need to clarify guidelines for post-acute care facilities. I have worked in a few facilities where they identify themselves as post-acute care and take in these residents, but are unable/unwilling to meet the care needs (ie: IV fluids for dehydration, disagreement on safety policies such as chair and bed alarms for residents who are unsafe to get up independently) which often results in unnecessary re-hospitalizations, falls, etc.

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