Whether the House bill, the Senate bill, or anything that may come out of reconciliation, Medicaid reimbursement for SNFs is going to get squeezed.
It is amazing the uproar, first over the House healthcare reform bill, and now the Senate bill. I have to admit, like Nancy Pelosi, I have not read either bill, and I also prefer to wait until something actually becomes law to see what it says. Will the ACA replacement cut Medicaid spending over 10 years by $834 billion in the House bill, or $772 billion in the Senate bill? Will the ranks of the uninsured grow by 23 million by 2026, or 22 million? Will the average skilled nursing facility lose $600,000 in annual Medicaid reimbursement under the Senate bill? From what I have seen, it is not that Medicaid spending will decrease, but that the growth rate will be lowered. In the Senate bill, I have read that Medicaid spending will be 30% higher 10 years from now, as opposed to the current trajectory of about 65% higher spending if nothing is done. A 30% increase alone will be hard to fund. Medicaid and Medicare reimbursement for generic skilled nursing care is going to be in for a rough ride for the next 10 years or more, and while the industry certainly should fight and lobby for every penny, it should also get ready for this reality. Paying $100,000 per bed for that 40-year old SNF will be even harder to rationalize. But it usually is.
