#Healthcare #Policy Impact: #PPACA & State #Medicaid Expansion & #Hospital Budgets

Here is a report on the funding challenges that are being thrust upon Hampton Roads, VA hospital and healthcare systems in relation to the Medicaid expansion aspects of the PPACA aka Obamacare.

The cost of increasing access to care for all the people previously not covered under health plans is going to be born by either taxpayers or those already paying the premiums – which really are the same people.  If the hospitals have to cut their services in the absence of Medicaid expansion in order to recoup the costs they already paid up front, it could precipitate the death spiral of the entire complicated scheme.

——————————————————————————————————————————————————————-

dailypress.com/news/politics/dp-nws-medicaid-expansion-0119-20140119,0,1276182.story

dailypress.com

Hospitals fear service cuts, layoffs without Medicaid expansion

By Dave Ress, dress@dailypress.com

Daily Press

January 19, 2014

Beds could close, nurses could lose jobs and it could be tougher for Hampton Roads families to find a place to have babies or get mental health care unless Virginia finds some way to pay for the hundreds of millions of dollars a year hospitals give the area’s poor and disabled, hospital executives say.

With the quid pro quo of the Affordable Care Act fractured because the General Assembly won’t move to expand Medicaid, almost $200 million will be drained from Hampton Roads’ health care system by the end of next year, estimates from the state hospital association suggest.

Hampton Roads hospital executives fear that layoffs and painful service cuts are the only way to keep their doors open without the $2 billion a year that Washington has promised to fund an expansion of Medicaid to cover more than 375,000 Virginians living below the poverty line.

“We’d have to be looking at reductions in force,” said Peter Bastone, chief executive of Chesapeake Regional Memorial Hospital. “I would have to reduce my beds … that means you don’t have as many people and you can’t serve as many people.”

The problem, said William B. Downey, president and chief executive of the eight-hospital, 400-physician Riverside Health System, is that “hospitals paid up front for the Affordable Care Act, Obamacare, call it what you will. Medicaid expansion was supposed to offset that.”

Without it, hospitals don’t know where to turn.

The commercial insurers offering coverage through the new Affordable Care Act insurance exchanges are pushing for cuts to hospital fees, Downey said. They’re seeking rates even lower than the deep cuts to Medicare and Medicaid fees hospitals agreed to in order to make the Affordable Care Act affordable. The legislation cuts other federal support for hospitals, too.

Medicaid expansion was supposed to pay hospitals for care to the indigent that those federal payments and the hospitals’ own charity had covered.

The idea of asking Virginia taxpayers to pay for care that a federally funded Medicaid expansion would cover doesn’t make sense to Hampton Roads hospital executives — not with Virginians set to pay $1.1 billion in Affordable Care Act taxes and fees this year and more in years after that. By 2022, the bill for Hampton Roads alone from Affordable Care Act cuts in payments to hospitals and doctors and in the taxes and fees everyone else pays will total $4.4 billion, according to a state hospital association estimate.

“We’ve already paid for this,” Downey said. “It’s like we would be triple-taxed.”

In any event, the budget now before the legislature calls for nearly $60 million of cuts in state payments to hospitals over the next two years.

If legislators don’t expand Medicaid, or find a way to hit up Virginia taxpayers for funds to offset a quarter billion dollars of Affordable Care Act cuts this year, the only alternative for hospitals is to cut costs, Downey said. That means fewer beds and services.

Large and small hospitals at risk

Big hospitals like Riverside Regional Medical Center and Chesapeake, which serve large numbers of indigent and Medicaid patients, and small community ones, like Riverside’s hospitals in Gloucester, Tappahannock and the Eastern Shore, are particularly vulnerable.

Riverside Regional is squeezed because Medicaid, which takes a notoriously tough line in setting fees it pays hospitals, now covers about 60 cents of each dollar of the cost of caring for its patients, Downey said.

Virginia limits Medicaid coverage to children from low-income families and only a small number of working parents or the disabled, earning just a few thousand dollars a year. Coverage for kids includes birth and prenatal care — but doesn’t pay the full cost of obstetrics, which has long been one of the biggest money drains for hospitals.

Mental health services are also tough to support financially.

“We can have people TDO’d who need to be at Eastern State, but there aren’t beds for them, so they stay with us for months with no payment,” said Downey, referring to the temporary detention orders that are a first step toward an involuntary hospitalization.

Trauma care, too, is costly.

“You need to staff 24 hours a day, seven days a week, with skilled nurses and specialized physicians,” Downey said. Many of the people who need that care don’t have insurance, and Riverside relies on income it gains from other services to pay for its trauma service.

Bastone is worried about how Chesapeake will maintain the same level of charity care it now offers — it provided $22 million of care to low-income Hampton Roads residents in 2012. Riverside, which provided $44 million of charity care at its main Newport News hospital and millions more at its other facilities, also provided support for five independent free clinics, with X-ray, surgical and other services those safety net facilities can’t offer, Downey said. Those community efforts will be tougher to afford at a time when, without Medicaid expansion, legislators are looking for a larger role for free clinics.

By the end of this year, Hampton Roads hospitals will have taken a $65 million hit from Affordable Care Act cuts to their fees and federal support, according to data gathered by the Virginia Hospital and Healthcare Association.

By the end of 2015, those steadily deepening cuts will add up to more than $120 million.

Even if the General Assembly votes this year to expand Medicaid, so that hospitals could tap the program in 2015, area hospitals still would have lost more than they gained.

And it’s far from certain the legislature will act.

McAuliffe versus Howell

While Gov. Terry McAuliffe said Medicaid expansion is a top priority, Speaker of the House William Howell is firmly opposed.

Howell says Virginia can’t count on Washington to stick to its promise to fund the whole cost of the expansion through 2016, and then phase in a state contribution capped at 10 percent by 2021. Other Republicans say Medicaid’s costs are already ballooning out of control, and say it makes no sense to make what they call a failing system even bigger.

But business groups, including the Virginia Chamber of Commerce and commercial insurers, fear not expanding Medicaid will mean higher costs for people with insurance.

“One way or another, we all contribute to subsidizing that care — either through taxes or increased insurance and provider rates. We definitely need to fill the gap in coverage and find a path moving toward extending coverage, whether it’s expanding Medicaid or Medicaid reform,” said Phil Wright, chief executive officer at Southampton Memorial Hospital in Franklin.

“We have restructured and found creative ways to become more efficient in the way we deliver care,” Wright said. “We review operations and staffing daily, by shift, and sometimes hourly to ensure staffing matches patient volume. If anything, these challenges have certainly heightened the emphasis on those processes already in place.”

Some Virginia hospitals have taken more drastic action.

Last fall, Wellmont Health Systems closed Lee Regional Medical Center in Pennington Gap, in far southwest Virginia, saying Virginia’s failure to expand Medicaid to make up for Affordable Care Act cuts meant it could not keep the 70-year-old hospital open.

In Winchester, Valley Health laid off 33 employees this month and decided not to fill 25 vacancies.

“This is a very difficult decision we had hoped to avoid,” said Valley Health CEO Mark H. Merrill. “Federal deficits, payment cuts included in the Affordable Care Act, declining volumes, the decision by the Virginia legislature not to expand Medicaid, and other factors have impacted our financial position and we must respond.”

Ress can be reached at 757-247-4535.S

Copyright © 2014, Newport News, Va., Daily Press

Patient Protection and Affordable Care Act and Morals

October 1, 2013 came and went as the first day open enrollment began for the Patient Protection and Affordable Care Act, or more commonly known as Obamacare.  Problems with accessing the enrollment website at http://www.healthcare.gov have been widely reported and commented by pundits pro and con.

I read today that the health insurance industry giants have partnered up (yet again) to offer aid to the embattled Obama administration to see if they can lend their expertise in getting the http://www.healthcare.gov website off the ground as bipartisan calls are starting to be made to hold senior government leaders accountable to the debacle.  Besides power lusting progressive politicians, the health insurance industry stands to lose the most with the government’s prolonged inability to corral the “sheeple” into its health insurance holding pen.

Mine is a moral and ethical objection that an industry(in this case mine) has partnered with the government to enact a tax penalty against all citizens simply for being alive and not wanting to purchase health insurance.  Who could have ever imagined that America would ever see a tax on the living imposed on its people?  The government does not care if there are segments of citizens who opt to live healthy and practice wellness in their daily living outside the prevailing healthcare system – making a conscience decision to not purchase something that they do not want nor need.  Instead, masking as a parent, it coerces them to buy something that they otherwise might not want to buy simply because the it has the might of the IRS to enforce penalties.  Might is not always right.  Countless polls show vast numbers of Americans (tens if not hundreds of millions) do not want this healthcare mandate to purchase insurance.  While the PPACA may be the law of the land, ushered in by a political party majority that obtained power via elections, it still does not make it a just law – even if the Supreme Court upheld it as some bullshit taxing power interpretation.

From Chief John Robert’s Ruling:.

“The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress’s power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to con­strue what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Con­gress’s power to tax.”

“The Framers created a Federal Government of limited powers, and assigned to this Court the duty of enforcing those limits. The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act. Under the Constitution, that judgment is reserved to the people.”

Mr. Chief Justice, let my judgement be known that I deny my consent to this government requirement/tax shakedown on the grounds that it is morally and ethically wrong to coerce a person to purchase something simply because they are alive, regardless of their income or wealth status or lack thereof.