Thread: Hospitals worry about caring for newly uninsured in GOP plan

Hospitals worry about caring for newly uninsured in GOP plan


Kelli Kennedy, Associated Press
Associated Press March 12, 2017
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Industry groups, conservatives oppose GOP health bill, saying it's similar to Obamacare


FORT LAUDERDALE, Fla. (AP) -- When Colorado expanded Medicaid coverage under former President Barack Obama's health care law, the largest provider in the Denver region hired more than 250 employees and built a $27 million primary care clinic and two new school-based clinics.

Emergency rooms visits stayed flat as Denver Health Medical Center directed many of the nearly 80,000 newly insured patients into one of its 10 community health centers, where newly hired social workers and mental health therapists provided services for some of the county's poorest residents. Demand for services at the new primary care clinic was almost immediate.

The hospital system, like others around the country, now is facing enormous uncertainty under the health care overhaul proposed by congressional Republicans.

The GOP plan would scale back the Medicaid expansion and take away direct federal subsidies to help consumers pay their health insurance premiums, replacing them with age-adjusted tax credits.

Denver Health could see revenue losses between $50 million and $85 million by 2020, which is between 5 and 9 percent of their annual revenue, according to the hospital's chief financial officer. Adding to the financial anxiety is that Denver Health and many other hospital systems and medical providers across the country still would be required to care for many of the same patients, even if they lost their health coverage. That would leave hospitals, state and local governments, or privately insured patients to foot the bill.

"If it's full removal of Medicaid expansion, we would have to make cuts on our system, and I really think that those cuts would roll back our progress and could paradoxically increase the cost of care by driving care back to where it shouldn't be — in the emergency rooms," said Dr. Bill Burman, interim chief executive for Denver Health.

Similar sentiments are being shared by hospital CEOs across the country as President Donald Trump and congressional Republicans make good on their promise to undo the Affordable Care Act.

The Republican plan would limit the amount of federal money available to states that opted to expand Medicaid, the state-federal program that provides health coverage to the poor and lower-income people. It also would overhaul the framework of Medicaid generally so that in the future states would receive a limited amount per person based on enrollment and costs. Health care advocates have said such a change would mean less Medicaid money for the states.

The Republican proposal would boost one revenue stream for hospitals that had been cut under Obama's plan — a pool of money helping hospitals that care for a disproportionately high share of uninsured patients. But hospital CEOs say that money will not come close to making up for the revenue lost if large numbers of people lose their health coverage.

The American Hospital Association, which represents nearly 5,000 institutions nationwide and the Catholic Health Association of the United States, the nation's largest not-for-profit health provider, wrote Congress warning that the bill would lead to significant cuts in a program that provides services to the most vulnerable.

"We are likely looking at situations where hospitals would close down service lines, shorten clinic hours and lay off staff," said Beth Feldpush, a senior vice president at America's Essential Hospitals.

The Affordable Care Act sought to get more people covered and give them access to primary care doctors, theoretically increasing the number of paying customers for hospital systems while diverting those people away from emergency rooms where they are more expensive to treat. About 22 million people have gained coverage through Medicaid and by buying private health insurance in the government-sponsored marketplaces that offer plans with subsidized premiums.

The national uninsured rate is below 9 percent, a historic low.

Moody's Investors Service said it expects that the legislation's provision to cap federal Medicaid payments to the states, starting in 2020, will cause states to reduce payments to hospitals. The legislation also would saddle hospitals with more unpaid bills and uninsured patients, particularly older ones who could now face much-higher premiums, according to Moody's.

"We believe that the effect of older enrollees losing coverage will outweigh the positive effect of younger people gaining coverage, given that older people have greater health care needs and as they lose coverage, hospitals would incur greater uncompensated care and bad-debt costs," the report states.

S&P Global Ratings wrote that the bill would add to existing stresses on hospitals, including rising costs for salaries and prescription drugs.

NYC Health + Hospitals, the largest public health system in the country that serves mostly low-income people, made a rare decision to create its own insurance plans to help maximize revenue in the changing health climate. One of its plans, granted under the Affordable Care Act, offered premiums of $20 or less per month to 70,000 low-income enrollees. An additional 96,000 people gained coverage in another insurance plan under Medicaid expansion.

One plan would be eliminated entirely under the bill and tens of thousands would lose coverage on the other under the Republican bill.

Stanley Brezenoff, the health system's interim president, says it's "particularly appalling" for the expanded Medicaid patients who spent years going without insurance. Many of them have substantial medical needs and finally were able to get into a routine of receiving regular medical care.

"It is a brutal assault on the health care system, especially as it applies to the people in greatest need with historically the least access to care," he said.

Rural hospitals are particularly at risk.

One of the most likely ways hospitals will make up for revenue losses is by increasing the amount they charge privately insured patients. But rural hospitals have less bargaining power to negotiate rates with insurers because they have such a small number of insured patients to begin with, said Bruce Rueben, president of the Florida Hospital Association.

At Jackson Health, a 100-bed hospital in rural Marianna in the Florida Panhandle, 90 percent of patients are receiving charity care because they are uninsured or on Medicaid. They are the working poor who make too little to qualify for subsidies under Affordable Care Act plans and too much to qualify for Medicaid under Florida's stringent standards, where you must be a pregnant woman, child or disabled for the most part to qualify.

Nearly 60 percent of the hospital's patients work in agriculture, growing peanuts and fresh produce.

Emergency room visits there continue to creep up every year by 2 to 3 percent, said chief financial officer Kevin Rovito.

"If they keep cutting the reimbursements for the hospital one way or another and we do disappear, then where are these patients going to go?" he said.

https://www.yahoo.com/news/hospitals...140155152.html

Get the illegals OFF our healthcare.

Get the poor people to work buying their own insurance.

Free vasectomies and tubal ligations. Quit having families YOU cannot afford to feed and pay for.

End the lifetime career of welfare and food stamps to breeders. Three year maximum lifetime benefit for one kid. That is it, then no more, zero, nada, zip!

No entitlement, no subsidies, no tax credits!

Simplify our taxes and give everyone a generous Standard Deduction to use towards your health insurance, day care, savings, buying, vacation...so budget and plan for a family wisely!

Stop giving out the freebies and penalizing others for responsible choices in life. And stop making single people pay more taxes...not fair.

As for the drug addicts...if you can afford YOUR heroin and drugs...you can afford your own damn treatment! I do not want to pay for it.

Don't know what they are worried about Obama care paid them nothing. All co-pays and deductibles according to a local hospital that ended up in financial crisis. A couple of years ago in June of of the year my husband and I had to go to the billing department after his radiation for my husbands cancer to figure out what we actually owed them, with co-pays and deductible 25-30 different bills coming in. The lady in the billing office stated that they had no received not $1.00 from Obama care claims, it was all co-pays and deductibles. They ended up a couple of months later with a Norvant sign was hanging on the local hospital.

Hospitals are worried about providing healthcare to illegal aliens and not receiving federal funds under the new Ryancare bill.

Don't know what they are worried about Obama care paid them nothing.

Obamacare covered all the cost for the uninsured and illegal aliens in the expanded Medicare & Medicaid.

Obamacare accepted everyone who signed up on exchanges and did not verify eligibility on anyone.

They will simply add to the bills of everyone else.

Maybe I just don't understand, but were people dying from not having medical treatment before Obamacare?

Did we really need a government healthcare plan?

I really don't understand it so maybe I shouldn't comment too much.

I do remember people telling me we needed a government healthcare plan to get the insurance companies out of healthcare. At the time, I suggested that since the insurance industry was one of the largest industries in America, if they didn't have a role in this, it wouldn't happen.

Also, I met a man - early 50's, healthy and he told me he just enrolled and would get his free. I asked him what he did - he said, "I take care of my Mother".

Remember when I write about our Period of Ironies and Opposites?

Well, this health care "crisis" is just another scam, an exploitation of the American People. Just like the illegal immigration scam where they used the phony "race card" to manipulate otherwise independent common sense reasonable Americans into flooding our country with illegal aliens draining US dry as a bone, the "health care crisis" is the same type of manipulation.

All common sense reasonable Americans need to stand back, cool down and look at the numbers.

Today with "Obamacare collapsing", we're talking about 11.4 million people insured by Obamacare exchanges out of 330 million Americans. We have 3 times that number of illegal aliens, well over 30 million illegal aliens, sucking on our entire system from jobs to schools, hospitals to welfare, and tax credits to criminal enterprises, drug trafficking and violent crimes.

This whole health care ruckus is over less than 4% of the US Population in a nation where no hospital can deny anyone emergency medical treatment in a country where 80% of US hospital are either 501 C 3 "charity" hospitals or government-owned.

If our STATES can't figure out how to take care of this 11.4 million people with their charity hospitals, government-owned hospitals, charity organizations, churches and other state and local resources, then no one can and everyone should just shut up, sit down and change the channel, because the problem is not and has never been the insurance industry, it's been the federal government that passed a law in 1945 called the McCarran-Ferguson Act that exempted the insurance industry from the Sherman Anti-Trust Act and Federal Trade Commission regulation, if the company was regulated by a state.

Repeal McCarran-Ferguson and watch this little problem evaporate overnight.

Other than that, the problem has always been with medical providers, not health insurers. Medical providers drive the cost, mainly hospitals, so they are the culprits in the cost of medical care and the price of insurance that covers those costs.

At this point, everyone needs to get on board with the GOP Health Care Plan and make some progress repealing the mandates and taxes of Obamacare, which is Phase I. Phase 2 deals with fixing the regulations and happens without Congress, so we can rely on Trump to fix the bad regulations. I don't think anyone seriously thinks he's not going to be reliable in whacking the hell out of nonsense regulations. Phase 3 is the repeal of McCarran Ferguson, which is erasing the lines, and Trump won't rest until this happens, it was a major campaign promise, something he truly believes in, he hates this special treatment of insurance companies that exempts them from laws with which every other industry in America must comply.

Phase 3 will happen fast. Phase 2 doesn't have to be complete for Congress to pass a repeal of McCarran-Ferguson. They can do that as soon as Phase I is done. They could do it now but they want to focus on repealing the mandates and taxes of Obamacare first to get those in place so they can move on quickly with tax reform and the new budget to fix the economy and bring our jobs back. When these jobs come back, they are the jobs that offer employer provided health insurance which solves much of the health insurance needs of those on Expanded Medicare and Obamacare Exchanges.

The health care "crisis" was never a health insurance problem. It was an economic problem with the loss of our manufacturing jobs at the same time as we were suffering massive immigration both legal and illegal. When we reverse the loss of manufacturing jobs, illegal immigration and excess legal immigration, we cure 80% of the "health care crisis".

As to the "rising cost of health care", well, insurance companies aren't responsible for that at all. Obviously they want lower health care costs. The culprits responsible for the "rising cost of health care" are hospitals and medical providers, mainly hospitals, over 80% are "charity" hospitals or government owned. It's hard to believe that "charities" and "government" would be cheating and gouging the public, especially sick people, so it was much easier to blame those awful for-profit insurance companies paying the bills, right? It wasn't the insurance companies driving up the "cost of health care", it was our charities and government taking advantage of sick people.

GOP Congressman: Trump ‘Ill-Advised’ on Obamacare Plan

Wednesday March 8 2017, 11:06 am

Rep. Dave Brat (R-Va.) said President Donald Trump is being “ill-advised” on Obamacare, saying the bill proposed by House GOP leadership falls woefully short during an interview Wednesday on “The Laura Ingraham Show.”

Brat blasted Republican leaders in Congress for unveiling a proposal that fails to fulfill the promise of completely repealing and replacing the Affordable Care Act. Insisting that Congress can technically repeal all of Obamacare, the Virginia congressman said Republicans are “goofing it all up.”

“Most of it hinges around the word ‘repeal,’ and I think President Trump has been ill-advised. They’re telling him this is a repeal. It is not.”

“Most of it hinges around the word ‘repeal,’ and I think President Trump has been ill-advised. They’re telling him this is a repeal. It is not. It does not repeal,” Brat said.

Brat predicted that Trump will soon hear the “wails that are going to come up” from the American people over what he considers an unacceptable piece of legislation.

“[Trump’s] not a policy wonk on health care, right? He’s just a great leader — he’s going to put the heat under all of us to get a lot of stuff done,” Brat said. “He’s reshaping the world. He’s reshaping the modern media and press and disciplining [them]. He’s getting immigration done right. The tax piece is going to be great. We’ve got to get there. But this is wonk stuff.”

Saying that Republicans would never vote for the new bill if Democrats had put it forward, Brat asked why the bill is even being considered in the first place.

“It’s politics. It’s the press. It’s pressure put on Republican members in weak districts. It’s about money and special interests. It’s about everything except the best policy for health care,” Brat said.

Although Trump has expressed his support for the House bill, Brat stressed the president didn’t “fully endorse it.”

“[Trump] said this bill is the first step. We’re going to negotiate … So I still see plenty of room for negotiation, and I hope he does because I don’t want him owning it,” Brat said. “If he owns the current bill, it’s going to be a weight around his neck … and it will weigh down his presidency because it will not reduce the cost of health care. And he’s been assured that it will. And that bill will not do it.”

Brat noted the House’s current bill does not eliminate the insurance regulations and allows Medicaid expansion, though slowed, to continue with “astronomical” costs.

“And the major piece that people need to understand — it’s a federal program. You do not want the federal government running your health care, right?” Brat said. “The major issue is we have to return this power back down to the states and to the people, and to the doctors and the hospitals and regulate them and let them provide the care that’s best for you as an individual. And it’s just that simple. But we’re not doing it. The bill right now does not do that.”

Although House Republicans have promised that many of these changes excluded in Phase 1 will occur in "Phase 3" of a three-step repeal and replace process, Brat said on a scale of one to 10, the likelihood this will actually happen is a "two."

"And, what your listeners need to know is we all voted for it when it didn't count," Brat continued. "The entire Senate Republicans and all House Republican members voted for the 2015 full repeal of Obamacare. And now that it counts, we're goofing it all up … We're putting up basically another entitlement program."

"And nothing in Obamacare had anything to do with getting us a better health system, lowering prices for the people out there, reducing medical care costs. None of that has happened," Brat added. "And right now, I've got a terrible sinking feeling that we are going to do the exact same thing."

https://conservativenews247.com/news...obamacare_plan

Families to pay price if maternity coverage gets cut in GOP's health care plan

Maybe this sounds too simplistic, but shouldn't 'families' pay for maternity costs?

When we had an unexpected, or surprise pregnancy, my husband was a police officer. He didn't make a lot of money, but with only one child and my salary, we were doing OK.

When the pregnancy occurred, we knew we had some work to do. Insurance with the police department was structured to care primarily care for him if he was hurt on the job - certainly no maternity benefits.

My insurance paid a whooping $100.

We began scrimping and saving. My husband worked 2 other part time jobs. When it became apparent that wouldn't get the job done, he gave up his police job. One he had wanted all his life, and went back into the business he was in because he could make enough to care for the family.

Never once did we consider someone else should be paying for this.