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Medicaid Expansion Brings Improvements to Expansion States

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.”

Safety-Net Hospitals Gird for Loss of Medicaid DSH Money

Safety-net hospitals and others will lose a significant portion of their Medicaid disproportionate share (Medicaid DSH) payments on November 22 unless Congress delays implementation of the cut in those payments that was mandated by the Affordable Care Act.

And hospitals that receive these payments are now preparing for the worst.

The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money.  The law’s reach has not proven to be as great as anticipated, however, and two developments since the law’s passage have put a damper on the expected rise in the number of insured Americans:  a court decision that made it optional for states to expand their Medicaid program and the repeal of the requirement that everyone purchase health insurance.

Four times Congress has voted to delay the Medicaid DSH cut because so many people remained uninsured.  Now, however, the most recent delay in implementation of the cut, via a provision in the continuing resolution currently funding the federal government, expires on November 21, and hospitals – many of them already with razor-thin margins – are preparing for the worst:  a major reduction of their federal Medicaid DSH money.

NASH has asked Congress to delay the implementation of Medicaid DSH cuts on numerous occasions, citing their potential impact on the ability of private-safety-net hospitals to serve their communities.  NASH most recently made this request in September, urging members of Congress to support the continuing bipartisan effort to delay the cut.

Learn more about the prospect of a major Medicaid DSH cut later this month, how it might affect safety-net hospitals – including the kinds of private safety-net hospitals represented by NASH – and what some hospitals are doing to prepare for the possibility in the Stateline article “Rural and Safety Net Hospitals Prepare for Cut in Federal Support.”

High-Deductible Plans Losing Luster Amid Low Unemployment

The competition for employees is leading more businesses to offer more generous health insurance plans in addition to high-deductible plans.

As health insurance premiums rose in recent years, more and more companies were offering their employees more high-deductible insurance options to help keep down the cost of premiums.  Now, however, with some workers clamoring for more conventional plans and businesses finding themselves in competition for workers at a time of low unemployment, more businesses are offering those conventional plans to their workers.

2020, in fact, will mark the third consecutive year during which the percentage of companies offering only high-deductible health insurance plans will fall.

Serving patients with high-deductible health insurance can pose a special challenge for private safety-net hospitals.  Often, patients in the low-income communities these hospitals serve cannot afford to pay their deductibles, leaving such hospitals to absorb the cost of this uncompensated care.

Learn more about how businesses are adjusting their health insurance offerings in response to employee demand and competitive concerns in the Kaiser Health News article “Employers are Scaling Back Their Dependence on High-Deductible Health Plans.”

Verma Hints at More Medicaid Changes, Deregulation

Stay tuned for more Medicaid changes, Centers for Medicare & Medicaid Services administrator Seema Verma told a Las Vegas health care gathering last week.

CMS, she told her audience, will

…soon outline new opportunities for states to flip the Medicaid paradigm and free themselves from federal micromanagement.

While Verma offered few details, one idea clearly emerged:  there will be more deregulation.  She insisted, for example, that Medicaid work requirements are not dead.  While such requirements have run into trouble in the courts in recent months, she explained that CMS is developing new implementation guidelines to address some of the challenges states have faced when introducing such requirements and made it clear that CMS would continue to approve state requests to require their Medicaid population to work or engage in volunteer activities.

Because they care for more Medicaid patients than the typical hospital, private safety-net hospitals could be disproportionately affected by any changes in the Medicaid program.

Learn more about Verma’s remarks and the context in which they were offered in the Healthcare Dive article “CMS chief Verma teases more Medicaid deregulation.”

Number of Uninsured Children on the Rise

The number of children insured by Medicaid and CHIP has fallen by more than one million over the past two years after reaching an all-time low (by percentage) in 2016.

Why?  According to the New York Times,

Some state and federal officials have portrayed the drop — 3 percent of enrolled children — as a success story, arguing that more Americans are getting coverage from employers in an improving economy. But there is growing evidence that administrative changes aimed at fighting fraud and waste — and rising fears of deportation in immigrant communities — are pushing large numbers of children out of the programs, and that many of them are now going without coverage. The declines are concentrated in a minority of states; in other places, public coverage has actually increased.  The declines appear to be greatest in states like Texas and Tennessee that subject Medicaid and CHIP eligibility to a higher degree of scrutiny than other states.  Declines also appear to be greater in places with larger numbers of immigrants who are wary of applying for Medicaid and CHIP or remaining in those programs in light of changes in federal “public charge” regulations.

Any increase in the number of uninsured children poses a challenge to private safety-net hospitals because these are the very hospitals to which low-income and uninsured families turn for care – regardless of whether they have health insurance.

Learn more about the various reasons for the decline of enrollment by children in Medicaid and CHIP in the New York Times article “Medicaid Now Covers a Million Fewer Children.”

 

NASH Takes First Position on Surprise Medical Bills

Congress should address surprise medical bills in a manner that protects patients from such bills and establishes a fair negotiating process between providers and insurers, the National Alliance of Safety-Net Hospitals declared in its first public statement about the surprise medical bill issue.

The statement, developed to coincide with NASH Advocacy Day in Washington, D.C. last week, explains that the biggest challenge in developing a means of addressing this problem is forging a solution that ensures that providers, including private safety-net hospitals, can negotiate adequate reimbursement for care they deliver outside of the provider networks of their patients’ insurers.

With this in mind, NASH encourages Congress to pursue a solution that follows four basic principles:

  • Surprise billing legislation should protect patients from surprise medical bills and balance billing for out-of-network services.
  • Insurers and providers should be required to negotiate, without a federal role or involvement, for payment for services provided to insured individuals by out-of-network providers.
  • Insurers should uphold the “prudent layperson standard” and provide emergency care for any condition that a prudent layperson would reasonably believe requires emergency care.
  • Federal policies should preserve rather than supersede existing state policies that meet federal minimum patient protections for insurance products that are within states’ jurisdiction.

Learn more from NASH’s new position statement on surprise medical bills.

NASH Seeks Medicaid Exemption From New Public Charge Regulation

Congress should exempt Medicaid enrollment from the criteria in a new federal regulation that defines “public charge” or even overturn that regulation entirely, the National Alliance of Safety-Net Hospitals has declared in a new position statement.

The new statement, developed to coincide with NASH Advocacy Day in Washington, D.C. last week, notes that the fear of being designated a public charge will discourage many immigrants, including those to whom the new regulation does not even apply, from obtaining the medical care they need.  As a result, as many as 13 million legal immigrants are expected to disenroll from Medicaid out of fear of being labeled a public charge or choose not to enroll in the program even though they are entitled to Medicaid benefits.  Those found to be public charges risk losing green card status or even deportation.

Such individuals, NASH believes, will inevitably turn to private safety-net hospitals and others for care when they are sick or injured, placing great financial stress on these hospitals and potentially jeopardizing their ability to serve their communities.  For this reason, NASH has urged Congress to remove Medicaid participation from the criteria defining a public charge or to overturn the new regulation completely.

Learn more in the new NASH position paper “Challenges Posed by the New Public Charge Regulation.”

 

NASH Reiterates Call for Delay of Medicaid DSH Cuts

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.

NASH Award to Rep. Kennedy

NASH has given its “Champion for Health Care Award” to Representative Joe Kennedy III (D-MA).

Rep. Kennedy received the award during last week’s NASH Advocacy Day in recognition of his “tireless advocacy of access to care for his constituents, the residents of Massachusetts, and all Americans.”

As a member of the House Energy and Commerce Committee’s Health Subcommittee, Representative Kennedy has introduced numerous bills to help ensure access to care.  As explained by Keith Hovan, CEO of both NASH and the Southcoast Health System, which is located in Mr. Kennedy district, “Representative Kennedy has fought to protect private safety-net hospitals from damaging cuts that would hinder our ability to care for our most vulnerable residents.  We are incredibly grateful for his leadership.”

Learn more about Representative Kennedy and the NASH Champion of Health Care Award here.

NASH Advocacy Day

Friday September 20, 2019 is NASH Advocacy Day in Washington, D.C.

Today, leaders of private safety-net hospitals have traveled to the nation’s capital from across the country for NASH Advocacy Day, during which members will meet with members of Congress and congressional and committee staff to discuss federal health care policy issues that affect the ability of private safety-net hospitals to serve their communities.

For the occasion, NASH has introduced three new policy position statements:  on the importance of delaying Medicaid disproportionate share (Medicaid DSH) cuts, surprise medical bills, and the new federal regulation governing so-called public charges.  See the new position papers here.

In addition, the National Alliance of Safety-Net Hospitals is presenting its “Champion for Health Care Award” to Representative Joe Kennedy III (D-MA) for “his tireless advocacy of access to care for his constituents, the residents of Massachusetts, and all Americans.”  See the news release announcing the award here.