In late December, PBS broadcast an interview with Centers for Medicare & Medicaid Services administrator Seema Verma. Kaiser Health News has published a transcript of excerpts from that interview during which Verma discusses Medicaid – including enrollment, eligibility, services, and children – Medicare for all, administration attempts to reduce health care costs, protection for people with pre-existing conditions, and more. Read those excerpts in the Kaiser Health News article “One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma.”
Preventing Medicaid DSH cuts, a fair approach to protecting patients from surprise medical bills, and reducing prescription drug costs are among the policy positions that the National Alliance of Safety-Net Hospitals recently shared with Congress.
In its message to Congress, NASH also asked lawmakers to protect 340B prescription drug discounts for private safety-net hospitals and to preserve dedicated funding for community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education.
Learn more about NASH’s end-of-year policy priorities from the message “Protect Safety-Net Hospitals and the Communities They Serve in Upcoming Budget and Legislative Deliberations” that NASH delivered yesterday to all 535 members of Congress.
The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”
The statement, an annual OMB document, organizes the priorities as follows:
- Facilitating patient-centered markets
- Fixing health care financing through protecting private insurance and Medicare
- Fixing health care financing through reforming the individual market
- Fixing health care financing through making the ACA and Medicaid fiscally sustainable
- Bringing value to health care through price and quality transparency
- Bringing value to health care through patient-centered health IT
- Bringing value to health care through deregulation, especially for coordinated care
- Bringing value to health care through tackling the high cost of prescription drugs
- Bringing value to health care through accelerated drug and device approval and reimbursement
- Promoting health and protecting life
- Addressing impactable health challenges: kidney health
- Addressing impactable health challenges: combatting the opioid crisis
- Protecting conscience and life at all stages
- Reducing the disease and death associated with tobacco use
- Promoting independence
- Returning TANF to promoting work, marriage and family
- Supporting adoption
- Empowering Americans to improve their nutrition
- Promoting flexibility for states, grantees, and regulated entities
Learn more about the regulatory directions the administration intends to take for the rest of its 2020 fiscal year in the newly released “Statement of Regulatory Priorities for Fiscal Year 2020.” Go here to see the complete list of regulations that the Department of Health and Human Services intends to pursue in FY 2020, including 55 by the Centers for Medicare & Medicaid Services (CMS).
Cuts in Medicaid DSH payments to hospitals will be delayed for another month after Congress passed, and the president signed, a continuing resolution to fund the federal government through December 20.
A cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states is mandated by the Affordable Care Act and has been delayed several times by Congress. If implemented, Medicaid DSH allotments to the states would be slashed $4 billion in FY 2020 and then $8 billion a year through FY 2025.
Cuts in allotments to the states would result in reductions of Medicaid DSH payments to DSH-eligible hospitals.
Medicaid DSH payments are a vital tool for helping private safety-net hospitals care for the low-income residents of their communities. All private safety-net hospitals receive such payments.
The current cut is only temporary and expires when the continuing resolution expires after December 20.
States that expanded their Medicaid programs under the Affordable Care Act have experienced fewer hospital admissions, shorter lengths of stays in the hospital, and lower hospital costs, according to a new Health Affairs study.
Specifically, they experienced:
- a 3.1 percent decline in inpatient days
- a 3.5 percent decrease in discharges for conditions considered “ambulatory care-sensitive,” such as diabetes, chronic respiratory problems, and pneumonia
- a reduction of nearly three percent in hospital costs.
NASH has long supported Medicaid expansion, which has enabled private safety-net hospitals to serve their communities more effectively.
Learn more about how Medicaid expansion has improved the health of the population in states that expanded their Medicaid programs in the Health Affairs study “Medicaid Expansion Associated With Reductions in Preventable Hospitalizations.”
Medicaid DSH money will be allocated among states based on a new methodology under a regulation adopted this week by the Centers for Medicare & Medicaid Services.
But it is not clear when that new methodology may actually be used.
Cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to states were mandated by the Affordable Care Act based on the expectation that the law would greatly reduced the number of uninsured Americans. While this has been the case, the decline in the number of uninsured has not been as great as expected. For this reason, Congress has on several occasions delayed the required Medicaid DSH cut.
That cut is now scheduled to take effect next week, on October 1, but a continuing resolution to fund the federal government, passed last week by the House and now under consideration by the Senate, would delay that cut again – at least until November 22.
Private safety-net hospitals view Medicaid DSH as an essential tool in their effort to serve the uninsured and underinsured residents of the low-income communities in which they are located and strongly oppose any reductions in Medicaid DSH allocations to the states. See a recent NASH policy statement on Medicaid DSH here.
Learn more about the new regulation governing the future allotments of Medicaid DSH money to the states and the prospects for Medicaid DSH allocation cuts being made anytime soon in the Healthcare Dive article “CMS finalizes Medicaid DSH cuts, but Congress could still delay” and see the regulation itself here.
NASH supports current, bipartisan efforts in Congress to delay Medicaid disproportionate share (Medicaid DSH) cuts required by the Affordable Care Act.
The National Alliance of Safety-Net Hospitals has long called for the delay or elimination of these Medicaid DSH cuts and reiterated this view in preparation for NASH Advocacy Day, which was held last week in Washington, D.C. In NASH’s view, Medicaid DSH is a vital tool for helping private safety-net hospitals serve residents of the low-income communities in which those hospitals are located.
NASH reinforced this position in a new position statement that notes that
While many Americans have taken advantage of the Affordable Care Act to obtain health insurance, millions remain uninsured…and the past two years have seen the number of uninsured Americans rise, not fall…Consequently, any decline now in Medicaid DSH payments could lead to an increase in the provision of charity care, possibly forcing hospitals to reduce services limit community outreach, and even reduce staff. Such measures could jeopardize access to care, not only for hospitals’ uninsured and low-income patients but also for their privately insured, Medicare, and Medicaid patients as well.
See the complete statement on delaying Medicaid DSH cuts here, on the NASH web site.
More than 15 million Americans who are currently entitled to free or subsidized health insurance are currently uninsured.
Among them are 11 million who are eligible for Medicaid but have not applied for benefits and 4.2 million who could afford insurance with the help of federal premium subsidies and either have decided not to take advantage of those subsidies or are unaware of the availability of such subsidies.
In addition, another two million people would be eligible for Medicaid if their states expanded their Medicaid program as authorized by the Affordable Care Act.
In light of such figures, it is not entirely surprising that the uninsured rate, according to the census bureau, rose last year for the first time since implementation of the Affordable Care Act. That uninsured rate, 15 percent at the time the law was adopted in 2010, fell to 7.9 percent in 2017 but rose to 8.5 percent in 2018. The uninsured rate has especially risen among Hispanics and the foreign born.
Another possible reason for the rise in the number of uninsured Americans: the federal government has greatly reduced its outreach effort to inform people about the various options they have for obtaining insurance.
Learn more about who is uninsured and why the uninsured rate has risen in the Washington Post story “Millions of Americans aren’t getting health insurance, even though they’re eligible for free or affordable plans.”
The Affordable Care Act is responsible for a major reduction in the disparity of insurance status among racial and ethnic minorities.
According to a new Commonwealth Fund analysis,
All U.S. racial and ethnic groups saw comparable, proportionate declines in uninsured rates… However, because uninsured rates started off much higher among Hispanic and black non-Hispanic adults than among white non-Hispanic adults, the coverage gap between blacks and whites declined from 11.0 percentage points in 2013 to 5.3 percentage points in 2017. Likewise, the coverage gap between Hispanics and non-Hispanic whites dropped from 25.4 points to 16.6 points.
Learn more about specific differences among racial and ethnic groups, differences based on residence in Medicaid expansion states and non-expansion states, and differences in securing public or private health insurance in the Commonwealth Fund study “Did the Affordable Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage?”
The rate of uninsured Americans rose in 2017, the first such increase since implementation of the Affordable Care Act.
According to a new Urban Institute study,
The increasing uninsurance rate between 2016 and 2017 was driven by losses of private nongroup coverage, such as that purchased in the health insurance marketplaces, and decreases in Medicaid and Children’s Health Insurance Program (CHIP) coverage (-0.4 percentage points each).
Overall, coverage losses were concentrated in the 19 states that did not expand Medicaid eligibility under the Affordable Care Act by July 1, 2017…Between 2016 and 2017, uninsurance held stable in Medicaid expansion states but increased by 0.5 percentage points in nonexpansion states.
The study also noted that these declines occurred at a time when the economy was considered strong, incomes were rising, and more employers were sponsoring insurance coverage.
Learn more about where and why the number of uninsured people rose in 2017 in the Urban Institute report “Health Insurance Coverage Declined for Nonelderly Americans Between 2016 and 2017, Primarily in States That Did Not Expand Medicaid.”