Medicaid DSH Delay Advances in Energy and Commerce Committee

Medicaid disproportionate share cuts would be delayed for two years under a proposal advanced last week by the Health Subcommittee of the House Energy and Commerce Committee.

The Medicaid DSH cuts, mandated by the Affordable Care Act, have already been delayed three times by Congress and could be on their way to a fourth delay if the proposal advanced by the Health Subcommittee is endorsed by the Energy and Commerce Committee and works its way to the full House of Representatives, where such a proposal is thought to enjoy wide support.

The National Alliance of Safety-Net Hospitals has long endorsed the delay and even the repeal of cuts in Medicaid DSH payments, doing so most recently in a letter earlier this year to Senate Finance Committee chairman Charles Grassley in which it argues that those cuts would be especially harmful to private safety-net hospitals.

Learn more about the possibility of another delay of Medicaid DSH cuts in the HealthLeaders article “House Panel Advances Surprise Bill Package.”

 

ACA Tied to Reduced Disparities in Cancer Care

Improved access to health insurance has led to reduced racial disparities in the diagnosis and treatment of cancer.

As reported by the Washington Post,

According to researchers involved in the racial-disparity study, before the ACA went into effect, African Americans with advanced cancer were 4.8 percentage points less likely to start treatment for their disease within 30 days of being given a diagnosis.  But today, black adults in states that expanded Medicaid under the law have almost entirely caught up with white patients in getting timely treatment, researchers said.

Another study found that since the reform law’s implementation in Medicaid expansion states, women are being diagnosed and treated earlier for ovarian cancer than they were in the past.

Many of these patients receiving more timely care are served by private safety-net hospitals, which care for more Medicaid patients than most community hospitals.

Researchers also note that disparities, so often viewed from a racial and socio-demographic perspective, are now being seen on a geographic basis depending on whether individual states expanded their Medicaid program.  As one observer explained,

We are moving from black-white disparities to Massachusetts versus Mississippi disparities.

Learn more from the Washington Post article “ACA linked to reduced racial disparities, earlier diagnosis and treatment in cancer care.”

 

Medicaid Expansion Helps Pregnant Women and Their Babies

An intuitive assumption now has evidence to support it:  Medicaid expansion has improved the health of pregnant women and their babies.

According to a new study from the Georgetown University Health Policy Institute’s Center for Children and Families,

…states that expand Medicaid improve the health of women of childbearing age:  increasing access to preventive care, reducing adverse health outcomes before, during and after pregnancies, and reducing maternal mortality rates.

Better health for women of childbearing age also means better health for their infants.  States that have expanded Medicaid under the Affordable Care Act saw a 50 percent greater reduction in infant mortality than non-expansion states.

Learn more, including specific health benefits enjoyed by pregnant women and their babies, in the Georgetown study “Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies.”

Medicaid DSH Delay Wins Bipartisan Support

More than 300 members of the U.S. House have joined a letter to House leadership urging a delay in Affordable Care Act-mandated cuts in Medicaid disproportionate share payments (Medicaid DSH).

The bipartisan letter notes that hospitals that receive Medicaid DSH funds cannot absorb the loss of revenue such a cut would bring.  That cut, scheduled to begin in FY 2020, would amount to a $4 billion reduction in nation-wide Medicaid DSH spending in FY 2020 and an $8 billion reduction in each of FY 2021, FY 2022, FY 2023, FY 2024, and FY 2025.

NASH was actively involved in urging House members to join the letter.  If implemented, the Medicaid DSH cuts would be especially harmful to NASH members and all private safety-net hospitals – and to the low-income residents of the communities they serve.

See the bipartisan letter seeking a delay of Medicaid DSH cuts here.

More Medicaid Matching Funds for Only Partial Medicaid Expansion?

The federal government is considering providing an unusual amount of federal Medicaid matching funding for only partial state Medicaid expansion.

At least that’s what Centers for Medicare & Medicaid Services administrator Seema Verma told a health care conference in Georgia last week.

The state of Georgia has proposes partially expanding its Medicaid population.  Under the Affordable Care Act, states that fully expand their Medicaid programs under the terms established by the 2010 health care law receive nine dollars in federal matching funds for every one dollar they spend on their Medicaid expansion population.  States that only partially expand their Medicaid programs, on the other hand, currently are eligible to receive only their usual federal matching rate:  generally one federal dollar for every state dollar, with states with higher poverty rates receiving as much as slightly more than three dollars for every state dollar they spend.

Last week, however, CMS’s Verma said that when Georgia submits its Medicaid waiver application to CMS seeking only partial expansion of its Medicaid program, the federal agency will consider providing Affordable Care Act-level Medicaid matching funds rather than the traditional federal Medicaid matching rate.

Such a policy shift could be very beneficial for private safety-net hospitals in states that have not expanded their Medicaid programs, extending coverage to some of the currently uninsured, low-income residents of the communities in which those hospitals are located.

Learn more about the Georgia plan for partial Medicaid expansion and the possibility of CMS treating it like an Affordable Care Act Medicaid expansion in the Atlanta Journal-Constitution article “Trump official open to increased funding for Georgia Medicaid waiver.”

Uninsured ED and Inpatient Visits Down Since ACA

Uninsured hospital admissions and emergency department visits are down since passage of the Affordable Care Act.

And Medicaid-covered admissions and ER visits are up, according to a new analysis.

The report, published on the JAMA Network Open, found that ER visits by uninsured patients fell from 16 percent to eight percent between 2006 and 2016, with most of this decline after 2014, while uninsured discharges fell from six percent to four percent.

The rate of uninsured ER visits declined, moreover, at a time when overall ER visits continued to rise.

While the Affordable Care Act is likely the cause of most of these changes, other contributing factors include the emergence of urgent care facilities, telemedicine, and free-standing ERs as well as new payment models and rules.

The study’s findings are especially good news for private safety-net hospitals because they care for so many more low-income patients than other hospitals and have benefited from the Affordable Care Act’s expansion of access to insurance, whether through Medicaid expansion or the private health insurance market.

Learn more in the JAMA Network Open article “US Emergency Department Visits and Hospital Discharges Among Uninsured Patients Before and After Implementation of the Affordable Care Act.”

NASH Asks Grassley, Senate Finance Committee to Delay Medicaid DSH Cut

Delay or eliminate the FY 2020 Medicaid disproportionate share payment cut, NASH has asked Senator Charles Grassley in a recent letter.

The cut, mandated by the Affordable Care Act but delayed three times by Congress, was envisioned as an appropriate response to what was expected to be a significant decrease in the number of uninsured Americans as a result of the 2010 health reform law.  In his news release, Senator Grassley, chairman of the Senate Finance Committee, notes that Congress has delayed implementing this Medicaid DSH cut three times and needs to address the issue definitively.

In its letter, NASH maintains that the Affordable Care Act has not reduced the number of uninsured Americans as much as anticipated, leaving private safety-net hospitals and others still to provide significant amounts of uncompensated care to their low-income and uninsured patients and therefore still in need of their full Medicaid DSH payments.

NASH also argues that uncertainty in the health care arena today – legislative and judicial challenges to the Affordable Care Act, states changing the eligibility criteria and benefits of their Medicaid programs, the instability of health insurance marketplaces, and more – makes this an inappropriate time to reduce payments to safety-net hospitals, possibly jeopardizing access to care in low-income areas as a result.

Learn more by reading Senator Grassley’s news release and NASH’s letter to him.

ACA Repeal Would Drive Up Uninsured, Uncompensated Care

At the same time that the Trump administration announced that it has asked a federal court to repeal the entire Affordable Care Act, the Urban Institute has published a report detailing the potential impact of the health care reform law’s repeal.

According to the Urban Institute report, repealing the entire Affordable Care Act would add almost 20 million Americans to the ranks of the uninsured.  Medicaid and CHIP enrollment would fall by 15.4 million people and millions of others would lose the tax credits they used to purchase insurance.  Some would purchase insurance with limited benefits and individual plan premiums would rise while others would go uninsured.

In addition, repeal of the Affordable Care Act would lead to an 82 percent increase in hospital uncompensated care, to more than $50 billion.  About half of the states would see the amount of uncompensated care provided by their hospitals double, the Urban Institute estimates.

Repeal of the Affordable Care Act would pose an especially great financial challenge for private safety-net hospitals because they care for so many Medicaid- and CHIP-covered and low-income patients who might lose their coverage if the reform law is repealed.

Learn more from the Healthcare Dive article “Killing ACA would lead to huge spikes in uncompensated care” and from the Urban Institute report State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA.

 

Trump Budget Brings Bad News for Private Safety-Net Hospitals

The FY 2020 federal budget proposed by the Trump administration this week would bring pain for private safety-net hospitals if adopted.

Highlights of the proposed spending plan include:

  • More than $135 billion in cuts in Medicare uncompensated care payments (Medicare DSH) and Medicare bad debt reimbursement over the next 10 years.
  • Continued extension of Medicare site-neutral payment outpatient policies.
  • $48 billion in cuts in graduate medical education spending over the next 10 years.
  • $26 billion in new Medicaid disproportionate share (Medicaid DSH) cuts.
  • Repeal of the Affordable Care Act’s Medicaid expansion and all funding to pay for that expansion.
  • Support for legislation to introduce Medicaid block grants and limits on spending per recipient.
  • New restrictions on the 340B program.

Responsibility for adopting a budget rests with Congress, not the president, and this proposed budget is considered unlikely to gain much support in Congress.

As appropriate, NASH will engage in advocacy in support of the needs of the nation’s private safety-net hospitals.

Learn more about the administration’s proposed budget from numerous media reports or by going directly to the source:  fact sheets the White House has prepared offering budget highlights and the budget document itself.

 

Hospital Groups Join NASH in Calling for Delay of Medicaid DSH Cuts

Seven hospital trade groups have written to congressional leaders asking them to delay Affordable Care Act-mandated cuts in Medicaid disproportionate share hospital payments (Medicaid DSH) that are scheduled to take effect in October of this year.

Their letter echoes a long-time advocacy priority of the National Alliance of Safety-Net Hospitals.

In their letter the groups, led by the American Hospital Association and the Association of American Medical Colleges, write of the underlying rationale for the Affordable Care Act mandate for Medicaid DSH cuts that

…the coverage rates envisioned under the ACA have not been fully realized, and tens of millions of Americans remain uninsured. In addition, Medicaid underpayment continues to pose ongoing financial challenges for hospitals treating our nation’s most vulnerable citizens.

NASH has long advocated such delaying Medicaid DSH cuts, most recently in comments to Congress in response to the proposed State Accountability, Flexibility, and Equity for Hospitals Act.

Delaying Medicaid DSH cuts also is identified as an advocacy priority of private safety-net hospitals in NASH’s 2019 policy and advocacy agenda.