‘Safety-net’ hos­pi­tals serve crit­i­cal need

Daily Local News (West Chester, PA) - - OPINION -

There’s no dis­put­ing the fact that the de­bate over the new­est Af­ford­able Care Act re­peal pro­posal, the bill pop­u­larly known as Gra­ham-Cas­sidy, got all the press in Wash­ing­ton D.C. in the past week.

But bub­bling right be­low the sur­face is a threat to a crit­i­cally important — but over­looked — fed­eral pro­gram that could hit tens of thousands of low-in­come Penn­syl­va­ni­ans where they live if Congress fails to act.

Since the 1980s, so-called “safety net” hos­pi­tals that serve a large number of low­in­come pa­tients, whose cov­er­age is not cov­ered by such third-party pay­ers as Med­i­caid, Medi­care or CHIP, have an­nu­ally re­ceived pay­ments to help off­set the un­com­pen­sated care they pro­vide to these pa­tients.

Taken to­gether, Penn­syl­va­nia hos­pi­tals cur­rently re­ceive about $609 mil­lion in these of “dis­pro­por­tion­ate share pay­ments,” with such providers as Pin­na­cle Health and Geisinger re­ceiv­ing more than $14 mil­lion in such as­sis­tance, ac­cord­ing to the most re­cent data.

Ac­cord­ing to pub­lished re­ports, thanks to a quirk in the Af­ford­able Care Act’s im­ple­men­ta­tion, these pay­ments were set to be grad­u­ally re­duced over eight years.

For each of the last three years, law­mak­ers au­tho­rized ex­ten­sions.

Un­less Congress acts, the first of a total of $43 bil­lion in pay­ment cuts will kick in start­ing Oct. 1.

That’s a re­duc­tion of about 19 per­cent na­tion­wide, the data shows. And in­dus­try ad­vo­cates say the cuts, if they’re al­lowed to pro­ceed, would be dev­as­tat­ing.

“If these cuts move for­ward, it’s going to be very hard for safety net hos­pi­tals to con­tinue to offer ser­vices to those in their com­mu­ni­ties who otherwise don’t have ac­cess to ev­ery­thing from pri­mary care vis­its to emer­gency care ser­vices,” Beth Feld­push, an in­dus­try ad­vo­cate for Amer­ica’s Essential Hos­pi­tals, told the trade pub­li­ca­tion, STAT, this week.

Penn­syl­va­nia hos­pi­tals stand to lose about $121 mil­lion in fis­cal 2018 if the pay­ments are not ex­tended.

Ac­cord­ing to data compiled by the Hos­pi­tal and Health­sys­tem As­so­ci­a­tion of Penn­syl­va­nia, the re­duc­tions in pay­ments to Key­stone State hos­pi­tals are ex­pected to in­crease an­nu­ally, hit­ting a high of $500 mil­lion by fis­cal 2024.

That’s a hit they can ill af­ford.

In fis­cal 2016, 49 Penn­syl­va­nia hos­pi­tals, or 29 per­cent of those statewide, posted neg­a­tive mar­gins.

Such a dra­matic re­duc­tion in fi­nan­cial sup­port could lead some of those hos­pi­tals to dra­mat­i­cally re­duce ser­vices or to close their doors en­tirely, the trade as­so­ci­a­tion warned in a po­si­tion pa­per.

Un­like most is­sues on Capi­tol Hill, the de­bate over these pay­ments is not a par­ti­san one.

The most re­cent pay­ment ex­ten­sion, ap­proved in 2015, passed the U.S. Se­nate by a vote of 92-8 in the Se­nate and by a vote 392-37 in the House.

At the time, Penn­syl­va­nia’s two United States Sen­a­tors, Demo­crat Bob Casey and Repub­li­can Pat Toomey, both voted to reau­tho­rize the pay­ments.

A spokesman for Toomey said Fri­day that the Le­high Val­ley Repub­li­can is “closely ex­am­in­ing how the Gra­ham-Cas­sidy pro­posal, which would undo Oba­macare’s (dis­pro­por­tion­ate share lan­guage) for cer­tain states, would af­fect Penn­syl­va­ni­ans.”

A spokes­woman for Casey said he con­tin­ues to sup­port ex­tend­ing the pay­ments.

Congress should move to reau­tho­rize the ex­ten­sion of these pay­ments. And Toomey should join Casey and re­main a ‘yes’ vote.

Such a dra­matic re­duc­tion in fi­nan­cial sup­port could lead some hos­pi­tals to dra­mat­i­cally re­duce ser­vices or to close their doors en­tirely.

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