Senate Republicans Healthcare Bill Would Ripple Through USVI; Some Seniors In Nursing Homes Would Be Sent Home

In May, Governor Kenneth Mapp announced that after successful lobbying from his administration in getting the federal government to increase the poverty level in the territory, an additional 19,000 Virgin Islanders had become eligible for Medicaid, the public health insurance program mostly for low-income people, though some middle-class disabled and elderly people also qualify. Back then, the governor hailed the development as a major benefit to residents, noting the large amounts of poor who live here, among them many elderly individuals living in nursing homes.

Mr. Mapp explained that the adjustment amounted to an additional $18 million in federal reimbursements, which has been increased from $6,500 to $11,770. The local government will now be reimbursed 55 percent to 100 percent of the cost of medical services provide to an adjusted total of 31,000 residents. If the requested increase in the official poverty level had not been approved by the federal government, the local government would have remained responsible for 100 percent of the cost of treating 19,000 individuals previously ineligible, the governor said.

But the victory might by short-lived, especially if the Senate Republicans’ Affordable Care Act replacement bill passes.

On Thursday, the Republican senators joined their House counterparts in proposing steep cuts to Medicaid. The Republicans hope to roll back what they see as an expanding and costly entitlement. However, little has been said about what would happen to older Americans — including U.S. Virgin Islanders — in nursing homes if the cuts were to take effect.

Federal law requires state Medicaid programs to cover nursing home care, but the states have a large say of how funding is provided to the facilities. If the Republicans get their way, states — and the U.S. Virgin Islands — would be under increasing pressure to cut funding, a move that would force some elderly individuals at nursing homes to be sent home.

While most Medicaid enrollees are children, pregnant women and nonelderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them, according to The New York Times.

The territory’s nursing home facilities have already been under increasing financial pressure, which has been exacerbated by the local government’s difficult fiscal position.

The big question now is whether the Senate bill will be able to pass. The measure was forged in private — even some Republicans had not see the contents of the bill until recently — and once it emerged from secrecy this week, it was immediately criticized as another Republican effort to enrich the rich further and make poorer the poor.

“The Senate bill, unveiled today, is not a health care bill,” former President Barack Obama wrote on his Facebook page on Thursday. “It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else.”

The bill was harshly criticized by Senator Dean Heller of Nevada on Friday, a vulnerable Republican facing re-election in 2018. “I cannot support a piece of legislation that takes insurance away from tens of millions of Americans,” he said at a news conference in Las Vegas, standing next to Nevada’s Republican governor, Brian Sandoval, who accepted federal funding under the Affordable Care Act to expand Medicaid.

The bill is expected to voted on soon and Mr. Heller is not ruling out the possibility of voting for the final version, pending some changes are made. Republicans need 50 votes to pass the measure.