Last week on June 18, Inside Health Policy reported that lobbying efforts were underway by organizations that represent Medicaid-dependent providers, such as home care services, establishments that care for the disabled, hospice care facilities, etc., to get a special carve-out from the employer health insurance mandate found in the Affordable Care Act (Obamacare.)  Under the health reform law, an employer with 50 or more employees is required to provide “affordable” health insurance and if they do not, the employer must pay a fine of anywhere between $2,000 to $3,000 per employee, depending on whether or not the employee gets a taxpayer subsidized credit in an Obamacare exchange.  However, because of the disastrous roll-out of Obamacare and other political concerns, the Obama Administration has delayed the employer mandate until January 1, 2015 or 2016, depending on the number of employees an employer has.

American Network of Community Options and Resources (ANCOR), which according to Inside Health Policy, represent “overwhelmingly Medicaid-dependent providers that rarely have any other source of revenue” are actively engaged in getting relief for their membership.  ANCOR’s Vice President of Policy Barbara Merrill said that although the majority of their members provide health insurance to their employees, over half believe their administrative costs will increase between 15 and 50 percent.  ANCOR is asking the Centers for Medicare and Medicaid Services (CMS) for some sort of relief such as to have the taxpayers reimburse the employer’s penalty for not providing health insurance.  Another solution they are looking at is some sort of transitional relief beyond what CMS has already done, such as providing limited but targeted federal matching tax dollars to the states in order for the providers to buy time to figure out solutions to the mandate problem.  One thing that Merrill says they are not advocating for is repeal from or an exemption to the employer mandate.  Nor are they looking to change to the definition of a full-time employee, which under Obamacare is a person that works 30 hours or more.

But according to Inside Health Policy report, other advocacy groups for Medicaid providers are looking at the aforementioned policy options.  The National Association for Home Care and Hospice (NAHC) wants a further delay in the employer mandate and other ideas, such as exempting home care workers from the mandate, changing the definition of a full-time employee, and more taxpayer funding to either pay for health insurance for the employer’s employees or the employer’s penalty if insurance is not provided.  Additional suggestions include allowing the employer’s full-time workers to also enroll in Medicaid, a “pass-through payment for commercial insurance enrollment,” and reducing administrative requirements to save in overall employer costs.

The organizations representing the Medicaid-dependent providers have also been successful in getting at least two congressional members involved in their issue.  The June 24 Inside Health Policy edition provided a copy of a letter Senator Tammy Baldwin (D-WI) and Rep. Ron Kind (D-WI) sent to Secretary of Health and Human Services (HHS) Sylvia Matthews Burwell on June 20.  They write about their concern the Obamacare employer mandate will have on Medicaid dependent home and community-based providers.  They argue that these organizations, which service Medicaid patients, run on “very slim margins” and have “raised unique concerns about complying with the ACA’s [Affordable Care Act] employer responsibility requirements.”  They state, “Medicaid dependent home and community-based providers could face significant financial burdens in complying with the employer responsibility requirements in the ACA.”  The elected officials close by saying, “In light of recent decisions to provide for transition relief with respect to implementing requirements in the new law, we request that HHS fully explore options to support Medicaid dependent home and community-based providers in complying with the ACA’s employer mandate responsibility requirements.”

Inside Health Policy notes that a congressional aide said it is unlikely any change can be made legislatively considering the political animosity around Obamacare and that the best approach is to work with CMS to get the changes.  The organizations have asked CMS to call a meeting that would include all the stakeholders to discuss ways to fix the employer mandate problem.  No doubt the letter from Baldwin and Kind will spur the administration to find some sort of solution for these types of employers.

CAGW agrees that Medicaid-dependent providers are facing a severe burden complying with the Obamacare employer mandate.  But so aren’t thousands of other employers who also operate on very thin margins, are struggling to stay afloat in a prolonged weak economy, and pay the taxes that fund Medicaid.  CAGW believes the employer mandate should be delayed permanently for all employers, along with the individual mandate.  Now those are some real solutions.

Unfortunately, the problem with Obamacare, or any federal program for that matter, is it invites the federal government to play politics and treat groups it favors differently than those it does not.  Expect a special carve-out for the Medicaid-dependent providers before the end of the year.

Here’s another thought.  Any governor thinking about expanding Medicaid to their citizens under the age of 65 with incomes up to 133 percent of the federal poverty level should pay close attention to what Baldwin and Kind stated in their letter about the government-run health insurance program.  They said, “The challenging economic conditions and tight budget environment have placed significant strain on state Medicaid programs in recent years.  As a result, provider payments have been cut or frozen across much of the country.”

Since Medicaid is in such fiscal trouble, why would any political leader want to bet their state’s budget on the belief that the federal government will provide 90 percent of the funding to expand Medicaid ad infinitum?  Governors Corbett (R-Penn.), McAuliffe (D-Va.), Pence (R-Ind.), and Herbert (R-Utah) are you paying attention?

CAGW has written about the folly of Medicaid expansion that includes a January Waste Watcher entitled “Medicaid Expansion – A Wolf in Sheep’s Clothing.”