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Congress wrangles over ACA funding as a government shutdown looms

July 26, 2013

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The fiscal year ends Monday at midnight, and the federal government is lurching toward a shutdown unless the House and Senate agree to a short-term funding plan and resolve a dispute over funding the “Patient Protection and Affordable Care Act” (ACA).

With action to approve a continuing resolution (CR) required in the Senate and then once again in the House, a down-to-the wire battle through the weekend is almost guaranteed. And when legislators are finished with the CR they will confront an even more volatile clash over increasing the government’s borrowing authority, with its credit rating and possible default on the line. The House Sept. 20 voted 230-189 to approve a CR that would fund most government programs at the current, postsequestration rate through Dec. 15, and defund the ACA.

The bill also would require the U.S. Treasury to make debt payments and pay Social Security benefits before other payments if the government reaches the debt ceiling.

The House sent the measure to the Senate. But Senate Majority Leader Harry Reid, D-NV, said his chamber will not pass any bill that defunds or delays the ACA. The Senate is expected to pass a CR that keeps the ACA funded and the government running only through Nov. 15.

In addition to the CR, Congress faces two other fiscal flashpoints with implications
for hospital funding and patient care. Congress needs to authorize an increase in the federal debt ceiling, probably by Oct. 17; and fix Medicare’s physician payment formula before the end of the year.

AHA Advocacy Day. With Congress at odds over the CR and how to address the deficit, more than 150 hospital leaders gathered last week on Capitol Hill to urge lawmakers to reject arbitrary funding cuts that hurt patients’ access to care.

“We have had plenty of cuts,” AHA President and CEO Rich Umbdenstock told hospital leaders participating in the AHA Advocacy Day event in person and via webcast. “We have certainly
 done more than our share to contribute to addressing these financial challenges, and it is time for Congress to identify other sources of revenue so that hospitals can be sure to be ready when needed.”

In addition to coming to an agreement on a CR, Congress faces a battle over raising the federal debt ceiling next month and needs to fix Medicare’s physician payment formula so physicians are not hit with a 25% cut in reimbursement beginning Jan. 1.

At last week’s Advocacy Day meeting, hospital leaders were briefed on key legislation, regulatory concerns and programs at risk for funding cuts in the looming federal budget debate.

After the briefing, they took their “no more cuts” message directly to legislators and their staff in meetings on Capitol Hill.

Steve Carlson, president and CEO of Community Medical Center in Missoula, MT, says reining in Recovery Audit Contractors (see pages 4-5) and eliminating the first two years of planned cuts to disproportionate share hospital (DSH) payments were his top issues. “A safety-net hospital like Community Medical Center is very dependent on DSH,” he said. “To take those cuts without the counterbalance of the reduction of bad debt is unfair.”

Carlson and the AHA are urging lawmakers to support the “DSH Reduction Relief Act,” H.R. 1920, which would delay for two years cuts to the Medicare and Medicaid DSH programs as the field weighs the impact of the ACA’s lower coverage estimates resulting from the Supreme Court’s 2012 decision that allows states to opt out of Medicaid expansion.

“For us, it’s [the DSH cuts] a loss of hundreds of thousands of dollars, and the implication is we would simply have to make cuts to counteract that,” Carlson said.

The AHA and hospital leaders also are pushing Congress to pass legislation that would assure unintentional billing disputes in federal health care programs aren’t penalized as fraud; renew lapsed Medicare payment measures that support small and rural hospitals; and protect the ability of many rural hospitals to provide a range of outpatient therapy services. For more on the AHA’s key legislative and regulatory issues, click on: http://tinyurl.com/mb5gja5.

Carl Hanson, CEO of Minidoka Memorial Hospital, a critical access hospital in Rupert, ID, said previous cuts in reimbursement have forced him to reduce the number of full-time employees by 13 – a significant number for a small rural hospital. Further payment cuts could mean more staff reductions and reduced access to services for patients in the rural community, he said. “They [lawmakers] can’t continue to just cut provider payments,” Hanson said. “We need real solutions.”

The next AHA Advocacy Day is scheduled for Oct. 29. For more information, click on the “Advocacy Days” icon at www.aha.org or contact the AHA’s Michael McCue at mmccue@aha.org.

 

By Pete Davis