The AHA Oct. 9 joined three other national hospital groups in urging senators to support S. 1555, the “DSH Reduction Relief Act,” which was recently introduced by Sen. Roger Wicker, R-MS. The bill is a companion measure to the House bill, H.R. 1920, which was introduced in May by Rep. John Lewis, D-GA. The legislation would delay for two years cuts to the Medicare and Medicaid Disproportionate Share Hospital (DSH) programs under the “Patient Protection and Affordable Care Act” (ACA).
“The legislation would allow states to further debate health care insurance coverage while lessening the adverse impact on hospitals, so our facilities can continue provide care to the nation’s most vulnerable populations,” the groups wrote senators. In addition to the AHA, the letter was signed by the Association of American Medical Colleges, the Catholic Health Association of the United States and the Federation of American Hospitals.
Wicker recently spoke to AHA News about his legislation.
AHA News: As a result of the Supreme Court’s 2012 decision, fewer people than originally estimated will be covered under the ACA, and the number of uninsured will not decrease to the levels projected; yet the scheduled reductions in DSH payments remain in statute. Do you believe a two-year delay in the DSH funding cuts will give hospitals across your state adequate time to allow for the coverage expansions mandated by the ACA to be more fully realized?
Wicker: Yes. The Obama administration’s insistence on cutting $22.1 billion from Medicare DSH payments was predicated on the assumption that the law’s mandates and expanded programs would reduce the number of uninsured and underinsured individuals.
However, many states have chosen to opt out of the law’s proposed Medicaid expansion, and the administration has provided countless waivers and delays of several of the most contentious mandates. Additionally, the nonpartisan Congressional Budget Office recently projected that, under the healthcare law, the number of uninsured in America will never fall below 30 million over the next decade. That is why it is so critical to delay the DSH cuts immediately.
Hospitals in my state of Mississippi are expected to lose tens of millions of dollars in reimbursement next year. Making matters worse, my state’s most underserved populations will lose access to care if the cuts are not delayed.
[My] legislation, S. 1555, will delay these cuts for two years and help ensure that our safety-net hospitals can continue providing our nation’s most vulnerable populations with access to quality care.
AHA News: What have you been hearing from Mississippi hospitals about the DSH funding cuts?
Wicker: Medical professionals throughout Mississippi have told me that the cuts could be detrimental to health care access. Hospitals, especially those in rural areas, might not be able to continue to operate if the law’s promises of increased insurance coverage is not met and their DSH payments are reduced.
AHA News: Are you concerned that your state’s health insurance marketplace may not be ready in the short term to provide coverage to needy Mississippi residents? Is that another reason to delay the cuts in DSH payments?
Wicker: I am deeply concerned that Mississippi’s health insurance marketplace is not ready for primetime. Since Oct. 1, the exchange has been riddled with delays, glitches, and very few options for consumers. People are quickly learning that these online exchanges are not easily accessible, navigable, or workable for Mississippi’s uninsured population.
In a report released in September, the federal government also estimated that the cost of a midrange plan under the exchanges will run $448 a month in Mississippi. That compares to an average of $328 in 47 states and the District of Columbia.
Based on these facts, I have concluded that cutting the DSH programs while delaying other aspects of the law is an injustice to our poor and underserved populations.
AHA News: How important are the Medicaid and Medicare DSH programs in helping hospitals serve your state’s most vulnerable citizens and in maintaining Mississippi’s health care safety net?
Wicker: Since the early 1980s, the DSH programs have provided vital financial support to Mississippi hospitals that serve low-income Medicare beneficiaries, the uninsured, and the underinsured. DSH payments are critical to helping these hospitals cover Medicaid and Medicare shortcomings and support safety-net services that benefit the entire community.
Mississippi is one of the most medically underserved states in the nation with the fewest doctors per capita. Even under the current levels of DSH funding, hospital costs for providing care to our vulnerable populations in Mississippi are not fully met. In 2012, a sample of three hospitals in the state provided more than $114 million of uncompensated care and only received $98 million in DSH payments.
Now is not the time to cut the legs out from under our safetynet hospitals. Too many people in Mississippi, and across the country, count on these facilities for access to their health care.