AHA chief doubts all states will expand Medicaid

The head of the leading hospital advocacy group is pessimistic that states will undertake the voluntary Medicaid expansion called for by the 2010 healthcare overhaul.

Richard Umbdenstock, president and CEO of the American Hospital Association, at a Thursday policy breakfast sponsored by a Washington politics publication, gave little chance that all states would expand their Medicaid programs after the U.S. Supreme Court struck down penalties for not doing so.

Umbdenstock said he “wished I could be as positive” about the likelihood of a full Medicaid expansion as two health policy experts at the same event who expressed confidence that states would expand fully. Many Republican governors have expressed hesitancy or outright opposition to expanding eligibility to their Medicaid programs to all residents with incomes of up to 133% of the federal poverty level, or as high as 138% of the federal poverty level by 2014. The governors have said their concerns about expansion are based on the large costs of various types that it will carry but critics counter that it is simply due to underlying political opposition to the Patient Protection and Affordable Care Act.

“I really anticipate that the macros are going to overtake the politics as the governors start to really understand what the economics are here for providers because the governor gets to decide whether these providers are going to go out of business,” said Dan Mendelson, president and CEO of Avalere Health. “And if you frame it up like that, it gets a little different from a political standpoint.”

Umbdenstock said hospitals and patient groups continue to push state leaders to expand their Medicaid programs, partly as a necessary offset to the disproportionate share hospital payment cuts that also were included in the healthcare law.

“To be cutting them through additional Medicaid reductions on top of what they are experiencing with their Medicare populations obviously is just going to be devastating,” he said.

The hospital group released a report Thursday (PDF) detailing the growing need for hospital safety net services and the challenges those facilities face in providing that care.

In July, the Congressional Budget Office estimated that the Medicaid expansion would cover six million fewer people than the 17 million it previously estimated because some states would partially expand their programs and others would not expand at all.



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