NASH Unveils 2019 Agenda

The National Alliance of Safety-Net Hospitals has unveiled its public policy advocacy agenda for 2019.

That agenda explains that NASH will:

  • Address Medicare issues such as continuing threats to private safety-net hospitals’ Medicare DSH payments, audits of the Medicare cost report’s S-10 form, graduate medical education payments, potential cuts in bad debt, 340B, the participation of private safety-net hospitals in value-based purchasing and alternative payment model programs, and the expected national conversation about “Medicare for all.”
  • Address Medicaid issues such as the adequacy of Medicaid DSH payments, possible reductions in Medicaid eligibility and benefits, the implications of a new proposal to define whether new immigrants and their families pose a threat of becoming “public charges,” the possible introduction of Medicaid block grants, and possible new restrictions on how states may finance their Medicaid programs.
  • Work to protect private safety-net hospitals from federal spending cuts.
  • Reintroduce itself to Congress and the administration.
  • Seek to enhance its ability to help shape government health care policy in Washington by recruiting more members.

For NASH’s complete 2019 advocacy agenda click here

CBO Targets Health Care in Options for Reducing Deficit

Every year the Congressional Budget Office publishes a menu of options for reducing federal spending and the federal budget deficit.  As in the past, this year’s compendium includes a number of options to reduce federal health care spending and raises federal revenue through health care initiatives.

The cost-cutting options include:

  • establish caps on federal spending for Medicaid
  • limit states’ taxes on health care providers
  • reduce federal Medicaid matching rates
  • change the cost-sharing rules for Medicare and restrict Medigap insurance
  • raise the age of eligibility for Medicare to 67
  • reduce Medicare’s coverage of bad debt
  • consolidate and reduce federal payments for graduate medical education at teaching hospitals
  • use an alternative measure of inflation to index social security and other mandatory programs

Options to raise additional revenue include:

  • increase premiums for Parts B and D of Medicare
  • reduce tax subsidies for employment-based health insurance
  • increase the payroll tax rate for Medicare hospital insurance

Many of these proposals, if implemented, would be damaging for private safety-net hospitals.

Learn more about the CBO’s recommendations, how they might be implemented, and their potential implications in the CBO report Options for Reducing the Deficit: 2019 to 2028.


President Proposes FY 2017 Budget

That budget proposal calls for numerous cuts in Medicare payments to hospitals, including significant reductions in Medicare bad debt reimbursement, medical education payments, and payments for inpatient rehabilitation services.

NAUH LogoIt also calls for restoring the Medicaid primary care payment increase through calendar year 2017.

NAUH has prepared a detailed memo outlining the potential implications of the proposed FY 2017 budget for private safety-net hospitals. Representatives of private safety-net hospitals may request a copy of this memo by using the “contact us” link at the top of this screen.

President Presents Proposed FY 2015 Budget

Yesterday the Obama administration unveiled its proposed FY 2015 federal budget.

NAUH LogoThe spending plan addresses a number of key matters for private safety-net hospitals, including proposed cuts in Medicare bad debt reimbursement, graduate medical education payments, market basket updates for selected providers, and more.

It also proposes increased spending to train more health care providers and to extend enhanced Medicaid primary care payments for another year.

The National Association of Urban Hospitals (NAUH) has prepared a memo summarizing the proposed budget with an emphasis on the issues most important to private safety-net hospitals.  To request a copy of that memo, please hit the “contact us” link here, on the home page of the NAUH web site.


Fiscal Cliff Poses Threat to Urban Safety-Net Hospitals

Congress and the Obama administration are now negotiating possible solutions to the fiscal cliff crisis.

A number of the solutions that have been discussed in the recent past would pose especially major problems for urban safety-net hospitals.  Those “solutions” include:

  • further reductions in annual Medicare updates
  • reductions in hospitals’ Medicare outpatient evaluation and management (E&M) fees
  • further reductions in Medicare bad debt reimbursement
  • new limits on the provider taxes states can levy to finance their Medicaid program
  • further reductions in Medicaid disproportionate share (Medicaid DSH) payments
  • a reduction in the rate at which the federal government matches states’ share of Medicaid spending (the federal medical assistance percentage, or FMAP)
  • delayed implementation of the Affordable Care Act’s Medicaid expansion

As these negotiations continue, members of the National Association of Urban Hospitals (NAUH) will remind their congressional delegations that such cuts could have disastrous implications for the nation’s private, non-profit urban safety-net hospitals.


Old Medicare Proposals Resurface in Fiscal Cliff Talks

Proposals for how to reduce federal Medicare spending that were once thought dead are finding new life in the current fiscal cliff crisis debate.

In particular, recommendations offered by the 2010 Bowles-Simpson commission are being recirculated as Congress and the White House search for ways to avert the fiscal cliff.

Among those that would affect hospitals are reductions in Medicare bad debt reimbursement and medical education payments.

Other proposals, such as increasing Medicare beneficiaries’ cost-sharing and limiting Medigap coverage, would probably lead to increased bad debt for urban safety-net hosptials that care for especially large numbers of low-income seniors.

Read about “The Return of Simpson-Bowles in the Medicare Debate” in this Medicare NewsGroup articleUS Capitol Dome.