Hundreds of hospitals around the country have signed a letter to congressional leaders (PDF) asking them to delay cuts to Medicaid supplemental funding for the care of the uninsured and low-income patients.
More than $18 billion in cuts for the Medicaid disproportionate share hospital funding are expected to take effect between 2014 and 2019. Those cuts were mandated by the Patient Protection and Affordable Care Act, which was passed with the expectation hospitals would deliver less uncompensated care because all states would expand Medicaid eligibility to adults earning up to 138% of the federal poverty level. But the U.S. Supreme Court last year made Medicaid expansion optional for the states, and about half the states have not expanded their programs.
In addition, there has been unexpectedly slow enrollment of uninsured Americans through the malfunctioning HealthCare.gov exchange website. With the DSH cuts starting, “it's a triple witching hour,” said Dr. Bruce Siegel, CEO of America's Essential Hospitals, a trade group for public and safety net hospitals.
The hospitals expected to be hit hardest by the cuts are those in states that are not expanding their Medicaid programs. America's Essential Hospitals says some hospitals serving rural areas already are shuttering their doors. If the cuts continue as planned, other hospitals likely will turn to layoffs and reducing services to offset financial losses, Siegel said.
The hospitals that signed the letter are asking for a freeze on the Medicaid DSH cuts for three years. This change would give stakeholders a better picture of the extent of Medicaid coverage expansion, since it's expected that at least some of the states that so far have not expanded their program will do so over the next several years, the hospitals say.
For instance, state hospital associations in non-expanding states such as Florida are pushing their lawmakers to “take the federal money and get people covered,” said Bruce Rueben, president of the Florida Hospital Association.
Hospital and state officials previously have warned congressional leaders about the likely impact of the DSH cuts. But they say in recent months federal lawmakers seem to take the issue more seriously as reports have emerged about the dire financial circumstances of some hospitals.
As a result of the news coverage, “you're seeing more people paying attention to what's going on because they are starting to see the real pain being caused in their communities,” said Kevin Boyle, a spokesman for the Georgia Hospital Association.
Still, it's an open question whether the White House and Senate Democrats would dare re-open any provisions of the healthcare reform law, because Republicans likely would try to use the opportunity to push through more sweeping changes.
None of the House and Senate leaders addressed in the letter have publicly commented on the hospitals' letter.
Sen. Roger Wicker (R-Miss.) and Rep. John Lewis (D-Ga.) have introduced bills to delay Medicaid DSH cuts for two years.