Hospitals Say Republican Plan Would Limit Care For Poor – Hartford Courant
Medicaid cuts under the Republican health care plan approved by the House would limit care for the poor, raise rates for insurers and push hospitals to reduce care, Connecticut hospital administrators said Friday.
The cuts, if implemented, “would limit access to needed care for the poor in our communities,” said Michael Daglio, president of Norwalk Hospital and chief strategy officer for the Western Connecticut Health Network.
“Coupled with the fact that Connecticut’s Medicaid reimbursement is among the lowest in the nation, we have to wonder how health care providers will be able to afford care to Medicaid patients in the future,” Daglio said.
In a wealthy state with a low Medicaid reimbursement rate, where legislators count on hospitals to pay hundreds of millions of dollars in state taxes a year and are considering allowing cities and towns to tax hospital property, additional cuts to Medicaid funding for low-income patients could lead to painful cutbacks or increased costs for services at Connecticut hospitals
Middlesex Hospital president and CEO Vincent Capece Jr. said if Medicaid funding for low-income patients is slashed, the hospital would have to make up that revenue somewhere else, like raising rates for commercial insurers. The hospital has already been cutting costs and searching for efficiencies, he said.
“We’ve done a lot over the last three or four years to keep the organization viable, but you get to a point where the amount of low-hanging fruit that’s available to you is less and less,” Capece said. “It’s a real concern.”
Rocco Orlando, senior vice president and chief medical officer for Hartford HealthCare, said cuts to Medicaid would be felt more acutely by Connecticut hospitals.
“We’re already in a situation where Medicaid rate payments are among the lowest in the nation,” he said. “We have already experienced those cuts and really, for care that we provide for folks under Medicaid, we’re being paid with 40-cent dollars. The result of rolling back of Medicaid would be even further reductions.”
The bill the House passed Thursday is likely to undergo substantial changes in the Senate, but as written it would reduce Medicaid payments by $880 billion over the next decade and cause an estimated 24 million people to lose their insurance coverage.
Connecticut, which expanded its Medicaid population under the Affordable Care Act, would lose as much as $1 billion in federal funds annually once the legislation is fully implemented, Gov. Dannel P. Malloy’s budget office estimated earlier this year.
“What they’re really doing and what they’re betting on is that states will have to withdraw from this program,” Malloy said during an appearance on MSNBC Friday afternoon. “States will be forced to end Obamacare as we know it because they won’t be able to afford to pay for it.”
Malloy’s budget director, Ben Barnes, said the state would have to further cut Medicaid reimbursement rates, reduce the number of people covered or cover fewer services.
“I think we’d end up having to limit who’s eligible and limit what services we cover — those are difficult things to do and they would require the legislature to sign off,” he said. “That would be a tough battle.”
Barnes said the bill represents billions of dollars of costs shifted from the federal government to the states, coming at a time when Connecticut’s budget is “not projected to be doing extraordinarily well,” coupled with large growth in pension and retiree costs.
“Cutting taxes by pushing costs onto the states is misguided,” he said. “I really can’t say enough how wrongheaded the direction … Congress is going in is in my mind.”
Becker’s Hospital Review, an industry publication, said hospitals will also see more uninsured patients showing up at their doors if the Republican bill is implemented in its current state, a burden that may be felt more by small community hospitals.
“At DKH we provide care to a large number of Medicaid patients,” said Day Kimball Healthcare president and CEO Joseph Adiletta. “If the AHCA bill passes in its current form, we would likely see a significant drop in Medicaid reimbursement along with a rise in uncompensated care. Both situations would cause additional financial stresses on our organization.”
Capece said having uninsured patients show up at the emergency room because they have nowhere else to turn is “not the best way to care for people.”
“It creates a whole host of issues and it impacts our ability to be efficient in the way we … deliver care,” he said. “You only want people in the ER who really need to be there. People showing up for primary care creates all sorts of problems.”
Angela Mattie, a professor and chair of health care management at Quinnipiac University’s School of Business, said the cost to treat the sicker, uninsured patients who show up at emergency departments will ultimately fall on health care providers and other consumers.
“The lack of insurance needs to be absorbed somewhere and we as a society pay for that,” she said. “Having a population without insurance coverage is not a good thing from a business sense.”