SNAP thanks members of Pennsylvania’s congressional delegation for voting to include a temporary delay of Medicaid DSH cuts in the continuing resolution that funds the federal government through November 21.
The insurance expansion made possible by the Affordable Care Act may be improving and even saving lives, some studies and anecdotal evidence suggest.
While observers warn that it is difficult to attempt to render a final verdict on the reform law’s insurance expansion and its impact, various studies and observations point to encouraging developments. Among them:
Pennsylvania is among the 37 states (including the District of Columbia) that took advantage of the Affordable Care Act to expand its Medicaid program.
Learn more about some of the documented and observed benefits of the Affordable Care Act’s improved access to health insurance in the Washington Post article “With the Affordable Care Act’s future in doubt, evidence grows that it saves lives.”
Medicaid DSH money will be allocated among states based on a new methodology under a regulation adopted this week by the Centers for Medicare & Medicaid Services.
But it is not clear when that new methodology may actually be used.
Cuts in Medicaid disproportionate share hospital (Medicaid DSH) allotments to states were mandated by the Affordable Care Act based on the expectation that the law would greatly reduced the number of uninsured Americans. While this has been the case, the decline in the number of uninsured has not been as great as expected. For this reason, Congress has on several occasions delayed the required Medicaid DSH cut.
That cut is now scheduled to take effect next week, on October 1, but a continuing resolution to fund the federal government, passed last week by the House and now under consideration by the Senate, would delay that cut again – at least until November 22.
Should the cut be implemented, Pennsylvania would lose 40 percent of its Medicaid DSH allotment from the federal government in FY alone and that cut would rise to 80 percent a year from FY 2021 through FY 2025. Pennsylvania safety-net hospitals view Medicaid DSH as an important part of their effort to care for the uninsured and underinsured residents of the low-income communities in which they are located.
Learn more about the new regulation governing the future allotments of Medicaid DSH money to the states and the prospects for Medicaid DSH allocation cuts being made anytime soon in the Healthcare Dive article “CMS finalizes Medicaid DSH cuts, but Congress could still delay” and see the regulation itself here.
Pennsylvania’s Medicaid resources should follow now-closed Hahnemann University Hospital’s Medicaid patients as those patients turn to new providers, the Safety-Net Association of Pennsylvania declared in a position statement issued this week.
According to SNAP,
…the best way to protect access to care and prevent additional financial strain on Philadelphia hospitals is to ensure that all state resources reallocated in the wake of Hahnemann University Hospital’s closure follow the displaced patients.
In preparation for addressing this challenge, SNAP performed a data-based analysis of where Medicaid patients turned for care upon the closing of St. Joseph’s Hospital, like Hahnemann a high-volume Medicaid provider and located in the same community as Hahnemann, in 2016. This analysis identified where patients went when St. Joseph’s closed and in its position statement, SNAP urges state policy-makers to perform similar analyses and ensure that state Medicaid resources, especially supplemental payments made to hospitals that serve especially large numbers of Medicaid patients, be distributed to the hospitals that actually serve displaced Hahnemann patients. Such an approach, SNAP maintains, is the best way to ensure the future of the health care safety net in Philadelphia.
Learn more in the SNAP position statement “Protecting Philadelphia’s Health Care Safety Net From the Financial Implications of the Closing of Hahnemann University Hospital.”
Undeterred by past defeats, members of PA’s state senate are again attempting to advance Medicaid work requirement legislation.
This time, the proposal to impose a Medicaid work requirement will add new flexibility to such a requirement, offering exemptions for individuals deemed “medically frail” and enabling individuals who do volunteer work, attend college, or who are actively looking for work to continue qualifying for Medicaid benefits.
The proposal will be considered by the Senate Health and Human Services Committee.
The legislature has passed two Medicaid work requirement bills in the past but Governor Tom Wolf has vetoed them.
Learn more about this latest effort to establish a Medicaid work requirement in Pennsylvania in the PA Post article “Wolf, Republicans resume tug-of-war over Medicaid work requirements.”
More than 15 million Americans who are currently entitled to free or subsidized health insurance are currently uninsured.
Among them are 11 million who are eligible for Medicaid but have not applied for benefits and 4.2 million who could afford insurance with the help of federal premium subsidies and either have decided not to take advantage of those subsidies or are unaware of the availability of such subsidies.
In addition, another two million people would be eligible for Medicaid if their states expanded their Medicaid program as authorized by the Affordable Care Act.
In light of such figures, it is not entirely surprising that the uninsured rate, according to the census bureau, rose last year for the first time since implementation of the Affordable Care Act. That uninsured rate, 15 percent at the time the law was adopted in 2010, fell to 7.9 percent in 2017 but rose to 8.5 percent in 2018. The uninsured rate has especially risen among Hispanics and the foreign born.
Another possible reason for the rise in the number of uninsured Americans: the federal government has greatly reduced its outreach effort to inform people about the various options they have for obtaining insurance.
In Pennsylvania, a state with a population of 12.8 million, the number of uninsured people increased just 700 from 2017 to 2018. 699,000 residents of the state are currently uninsured.
Learn more about who is uninsured and why the uninsured rate has risen in the Washington Post story “Millions of Americans aren’t getting health insurance, even though they’re eligible for free or affordable plans.”
SNAP urges state policy-makers to ensure access to care in Philadelphia by directing Medicaid resources previously received by the now-closed Hahnemann University Hospital to the providers to which displaced Hahnemann patients now turn for care.
The Affordable Care Act is responsible for a major reduction in the disparity of insurance status among racial and ethnic minorities.
According to a new Commonwealth Fund analysis,
All U.S. racial and ethnic groups saw comparable, proportionate declines in uninsured rates… However, because uninsured rates started off much higher among Hispanic and black non-Hispanic adults than among white non-Hispanic adults, the coverage gap between blacks and whites declined from 11.0 percentage points in 2013 to 5.3 percentage points in 2017. Likewise, the coverage gap between Hispanics and non-Hispanic whites dropped from 25.4 points to 16.6 points.
Learn more about specific differences among racial and ethnic groups, differences based on residence in Medicaid expansion states and non-expansion states, and differences in securing public or private health insurance in the Commonwealth Fund study “Did the Affordable Care Act Reduce Racial and Ethnic Disparities in Health Insurance Coverage?”
Legal immigrants may become reluctant to seek government-sponsored health care and providers may find themselves delivering more uncompensated care in the wake of the adoption of a new federal “public charge” regulation that seeks to define more narrowly the kinds of individuals who should be granted entry to the U.S. in the future.
The new Department of Homeland Security regulation, while focused on applicants for entry into the U.S., could have the unintended effect of discouraging legal immigrants from enrolling in Medicaid, CHIP, and other government programs and even lead them to disenroll from such programs out of a mistaken concern that participating in such programs could jeopardize their status as legal immigrants. The Kaiser Family Foundation, in fact, estimates that two to three million people will leave Medicaid and CHIP because of the new regulation.
More than a quarter of a million interested parties responded to the proposed regulation, which was published last October, and since its release last week a wide variety of groups, ranging from the American Hospital Association and America’s Essential Hospitals to the American Council of Pediatrics, have noted the new regulation’s potential impact with alarm. Hospitals, in particular, are concerned that if people disenroll from Medicaid and CHIP, they will end up providing more uncompensated care to patients who previously had health insurance through those two public programs.
This could be especially challenging for Pennsylvania safety-net hospitals that are located in communities with large numbers of low-income legal immigrants.
Learn more about the new public charge regulation and health care providers’ reaction to it in the Fierce Healthcare article “Healthcare industry groups warn final ‘public charge’ rule could impact immigrant health, drive up costs.”
Overdose deaths in Pennsylvania fell 18 percent from 2017 to 2018, according to a news release issued by Governor Wolf’s office.
The decline results, according to the news release, from a combination of prevention, rescue, and treatment. These and efforts, including the distribution of free naloxone, a drug that helps rescue those who have overdosed on some drugs, have been funded in part by a grant from the U.S. Substance Abuse and Mental Health Services Administration and Pennsylvania’s own Substance Use Disorder Loan Repayment Program, which assists health care professionals who work in the behavioral health field with the cost of their education.
At the same time, however, overdose deaths in Pennsylvania from stimulants such as cocaine and methamphetamines continue to rise.
Learn more about the decline in overdose deaths in Pennsylvania and how it has come about from a news release from the governor’s office and the Johnstown Tribune-Democrat article “State OD deaths dropped 18 percent in 2018; stimulant deaths rose.”