The Supreme Court's decision to uphold the Patient Protection and Affordable Care Act but limit Congress' power to strip Medicaid funding from states that chose to not expand coverage presents an obstacle for disproportionate share hospitals: fairly dramatic cuts to DSH funding — 25 to 50 percent reductions — are written into the PPACA in anticipation of extended Medicaid coverage in all states. But some states have already declared they will opt-out of expansion.
National Association of Public Hospitals and Health Systems President and CEO Bruce Siegel, MD, MPH, keeps a close watch on DSH funding, as it is a significant source of funding for hospitals in his association. Here, Dr. Siegel shares some of his concerns in the wake of the Supreme Court's decision.
Question: What were your initial feelings when you heard the Supreme Court's ruling?
Dr. Bruce Siegel: Like many, we had mixed feelings when the Court announced its decision. Certainly, we were pleased the Court upheld the law's individual mandate and other provisions to drive greater insurance coverage and promote quality and innovation. But the decision on Medicaid, which allows states to forgo expansion, left us deeply concerned. It creates the potential for states to leave millions of people — especially those in vulnerable populations — without access to essential healthcare services. The responses of many states since the ruling and the recent Congressional Budget Office analysis confirm those fears and, in our view, demand an even greater sense of urgency to find solutions.
Q: How does the decision specifically affect hospitals your association represents?
BS: The decision on Medicaid expansion could have profoundly damaging consequences for safety net hospitals and health systems. The Patient Protection and Affordable Care Act makes deep cuts to federal DSH payments, which help compensate safety net hospitals for the care they provide to the uninsured. Those cuts were premised on the expected increase in insurance coverage through the health insurance exchanges and expanded Medicaid eligibility. But now, that careful balance is gone, and safety net hospitals in many states might face a nightmare scenario: crippling cuts to DSH payments and continuing significant numbers of uninsured patients seeking care.
Q: What is NAPH lobbying for given the Court's decision that ultimately allows states to opt-out of Medicaid expansion?
BS: Our focus now is on preserving safety net care for low-income and other vulnerable populations. How we accomplish that might require a combination of approaches. But, certainly, Congress and the administration must review the DSH reductions in light of the Court's decision. We already have made clear our concerns to lawmakers and senior officials at the U.S. Department of Health and Human Services, and we will work with them and other stakeholders as healthcare reform moves forward.
Q: How can public hospitals in states that choose to opt-out survive funding cuts?
BS: There are only two ways to solve the nation's healthcare coverage problem: Provide insurance — the preferred option — or provide access to a reliable, sustainable safety net. It's possible neither will happen in some states. Beyond that, there are few good options. Some hospitals might have to scale back services — community clinics, for example — and others might simply close their doors. Local governments might have to raise taxes to fill the funding gap. The outlook is not good.
Q: Will you lobby HHS to provide more DSH funding to public hospitals in states that opt-out? Is there another solution?
BS: We've expressed our concerns to the administration about the looming DSH cuts and asked that the agency's formula for allocating the cuts across states recognize the changing landscape of Medicaid expansion. We believe states should target DSH support to the patients and hospitals in greatest need.
Q: What is NAPH's plan of action in the coming months?
BS: NAPH will be in active and ongoing contact with Congress and the administration on a number of PPACA-related issues that will negatively affect our members, including the DSH cuts and other hospital payment reductions, as well as costly new regulatory requirements. We also will support our member institutions as they work to encourage Medicaid expansion in their states.
Georgia Medicaid Lists Hospital "Winners" and "Losers" of Provider Fee
13 States That Have Cut Medicaid
National Association of Public Hospitals and Health Systems President and CEO Bruce Siegel, MD, MPH, keeps a close watch on DSH funding, as it is a significant source of funding for hospitals in his association. Here, Dr. Siegel shares some of his concerns in the wake of the Supreme Court's decision.
Question: What were your initial feelings when you heard the Supreme Court's ruling?Dr. Bruce Siegel: Like many, we had mixed feelings when the Court announced its decision. Certainly, we were pleased the Court upheld the law's individual mandate and other provisions to drive greater insurance coverage and promote quality and innovation. But the decision on Medicaid, which allows states to forgo expansion, left us deeply concerned. It creates the potential for states to leave millions of people — especially those in vulnerable populations — without access to essential healthcare services. The responses of many states since the ruling and the recent Congressional Budget Office analysis confirm those fears and, in our view, demand an even greater sense of urgency to find solutions.
Q: How does the decision specifically affect hospitals your association represents?
BS: The decision on Medicaid expansion could have profoundly damaging consequences for safety net hospitals and health systems. The Patient Protection and Affordable Care Act makes deep cuts to federal DSH payments, which help compensate safety net hospitals for the care they provide to the uninsured. Those cuts were premised on the expected increase in insurance coverage through the health insurance exchanges and expanded Medicaid eligibility. But now, that careful balance is gone, and safety net hospitals in many states might face a nightmare scenario: crippling cuts to DSH payments and continuing significant numbers of uninsured patients seeking care.
Q: What is NAPH lobbying for given the Court's decision that ultimately allows states to opt-out of Medicaid expansion?
BS: Our focus now is on preserving safety net care for low-income and other vulnerable populations. How we accomplish that might require a combination of approaches. But, certainly, Congress and the administration must review the DSH reductions in light of the Court's decision. We already have made clear our concerns to lawmakers and senior officials at the U.S. Department of Health and Human Services, and we will work with them and other stakeholders as healthcare reform moves forward.
Q: How can public hospitals in states that choose to opt-out survive funding cuts?
BS: There are only two ways to solve the nation's healthcare coverage problem: Provide insurance — the preferred option — or provide access to a reliable, sustainable safety net. It's possible neither will happen in some states. Beyond that, there are few good options. Some hospitals might have to scale back services — community clinics, for example — and others might simply close their doors. Local governments might have to raise taxes to fill the funding gap. The outlook is not good.
Q: Will you lobby HHS to provide more DSH funding to public hospitals in states that opt-out? Is there another solution?
BS: We've expressed our concerns to the administration about the looming DSH cuts and asked that the agency's formula for allocating the cuts across states recognize the changing landscape of Medicaid expansion. We believe states should target DSH support to the patients and hospitals in greatest need.
Q: What is NAPH's plan of action in the coming months?
BS: NAPH will be in active and ongoing contact with Congress and the administration on a number of PPACA-related issues that will negatively affect our members, including the DSH cuts and other hospital payment reductions, as well as costly new regulatory requirements. We also will support our member institutions as they work to encourage Medicaid expansion in their states.
More Articles Related to Medicaid:
CBO: Supreme Court Decision to Make Medicaid Expansion Optional Saves $84BGeorgia Medicaid Lists Hospital "Winners" and "Losers" of Provider Fee
13 States That Have Cut Medicaid