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AHA warns of clinical, fiscal disaster if ACA repealed

The American Hospital Association (AHA) and Federation of American Hospitals (FAH) warn of  possible clinical and financial catastrophe if the Affordable Care Act is repealed, as the Republicans have vowed to do.  They  released this statement:

“The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) {have} sent letters to President-elect Trump and Congressional leaders highlighting a new report that details the impact a potential repeal of the Affordable Care Act (ACA) would have on hospitals and health systems as they strive to care for their communities.”

To read the report, please hit this link.

The AHA and FHA press release went on:

Rick Pollack, AHA president and CEO, and Chip Kahn, FAH president and CEO, stressed that health coverage is key to ensuring patients have access to the care they need.  They noted that any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it.  They also highlighted the important role hospitals play in providing essential medical services and critical public health infrastructure.

It appears Congress is moving to reconsider the ACA in the early days of the new year without enacting accompanying legislation specifically guaranteeing similar coverage for those who will lose it.  If that approach is taken, they asked that any repeal legislation prospectively restore key hospital reductions included in the ACA to offset the cost of providing coverage. In that instance, the groups stated:

“… [W]e respectfully urge you to also include in such legislation the prospective repeal of funding reductions for Medicare and Medicaid hospital services for patient care that were included in the ACA for purposes of helping fund coverage for the insured. Specifically, we seek your support for the restoration of the Medicare hospital inflation update, as well as Medicare and Medicaid Disproportionate Share Hospital (DSH) payments that support those facilities that take care of high volumes of uninsured, poor and disabled Americans. Restoring these cuts for the future is absolutely essential to enable hospitals and health systems to provide the care that the patients and communities we serve both expect and deserve.”

The report, which was commissioned by the AHA and FAH, was prepared by the health care economics firm Dobson/ DaVanzo. The report finds that, under the most recent repeal without replacement bill, H.R. 3762, hospitals would face a net negative impact of $165.8 billion from 2018-2026 after accounting for the restoration of the Medicaid DSH cuts that H.R. 3762 contemplates. It also found that hospitals would suffer a loss of $289.5 billion in Medicare inflation updates if the payment reductions in the ACA are not restored. Finally, the study authors calculate that the impact of retaining the Medicare and Medicaid DSH reductions would amount to $102.9 billion.

“Losses of this magnitude cannot be sustained and will adversely impact patients’ access to care, decimate hospitals’ and health systems’ ability to provide services, weaken local economies that hospitals help sustain and grow, and result in massive job losses. As you know, hospitals are often the largest employer in many communities, and more than half of a hospital’s budget is devoted to supporting the salaries and benefits of caregivers who provide 24/7 coverage, which cannot be replaced,” wrote Pollack and Kahn.

The letter also calls attention to a second Dobson | DaVanzo analysis that estimates the cumulative federal payment reductions to hospital services that have been imposed through other Congressional and Executive Branch actions subsequent to and independent of the ACA. These reductions alone total another $148 billion from 2010 – 2026, and come on top of the ACA reductions.

Pollack and Kahn concluded the letter by committing to work with the President-elect Trump and Congress during this challenging process and reiterating the importance of properly funding hospital services.

They wrote, “As you begin reconsideration of the ACA, we want to be a constructive partner in this discussion. We strongly believe that any repeal legislation must be accompanied by provisions that protect the coverage for those currently receiving such protection. However, if that is not the legislative path to be pursued, then it is vital that such legislation provide a true clean slate and also include repeal of the reductions in payments for hospitals services embedded in the ACA – specifically the substantial reductions to hospitals’ annual inflation updates and the cuts to Medicare and Medicaid DSH payments. If the coverage associated with the ACA disappears, the importance of these payments would be heightened – they are vital in helping defray the costs of treating our most vulnerable patients.”


Medicaid overpayment problem threatens some W.Va. hospitals


The Charleston (W.Va.) Gazette Mail reports that some rural hospitals in that state might go bankrupt if the Feds try to force them to pay millions  of dollars in possible Medicaid overpayments.

The paper reported that Boone Memorial Hospital, Minnie Hamilton Health System, Roane General Hospital, Grafton City Hospital, Jackson General Hospital, Pocahontas Memorial Hospital and Sistersville General Hospital–might be compelled to repay Medicaid payments from the Disproportionate Share Hospital program (DSH). The DSH program is being phased out under the Affordable Care Act.

The problem is that all these hospitals have also runat least one rural health clinic. The Centers for Medicare & Medicaid Services is apparently taking back clinic-related DSH payments made to the hospitals from 2011 to 2015. The repayments would total $8 million, with repayments from individual hospitals  ranging from $28,000 to $1.8 million.

West Virginia is a poor state and so more than three-quarters of the patients are enrolled in Medicaid or lack insurance.

To read the article, please hit this link.


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