With an influx of newly insured patients under health reform and the prospect of more growth, executives with Tenet Healthcare Corp. and Community Health Systems downplayed legal and political threats to the law and outlined strategies to more aggressively enroll more uninsured in health plans.
Dallas-based Tenet and Franklin, Tenn.-based Community Health Systems reported Monday that their third-quarter performance benefited from the Patient Protection and Affordable Care Act as fewer uninsured patients visited hospitals and clinics where states expanded Medicaid eligibility under the law. The hospital chains also reported growing numbers of patients with commercial insurance sold through state exchanges, where low- to mid-income households can get subsidized health plans.
But the midterm elections and a possible Supreme Court decision on access to subsidies in some states have extended the uncertainty that has clouded the law since its passage in 2010. Medicaid expansion is in play in some states where political power may shift. The Supreme Court, meanwhile, is expected to decide soon whether to review a case that challenges the use of subsidies in states that rely on HHS to operate their insurance exchange.
Neither prospect seemed to unsettle Tenet and CHS executives who discussed the year so far and the coming year with analysts on Election Day.
“I think the reality is, with respect to the Republican control of the senate, the ACA marketplaces and benefits are so deeply established across so much of the country now, it's really hard to imagine taking that on as a fight and trying to dismantle it,” said Trevor Fetter, president and CEO of Tenet. “Tweaking it? Fine. We could expect that.”
Similarly, too many Americans now benefit from subsidies and states would find ways to work around any Supreme Court decision that could limit their access, Community Health Systems CEO Wayne Smith said.
The companies, too, benefited from the subsidies and Medicaid expansion, and executives said their efforts to enroll uninsured patients in health plans will be more aggressive this year than in the first enrollment push.
W. Larry Cash, chief financial officer for CHS, said the company has 800 counselors certified to help consumers find health plans this year compared with 400 counselors last year. The company also is directly contacting recent patients who lack insurance and posting notices in healthcare facilities and community locations.
So far in 2014, CHS has seen a boost of $80 million to $90 million from the Affordable Care Act, Cash said.
Tenet, meanwhile, is benefitting from its efforts last year to get its hospitals covered by the lowest-price health plans sold on the Affordable Care Act exchanges. The law accounted for 40% of the company's growth in volume.
Executives said the coming year may also bring new opportunities in states that delayed Medicaid expansion or may yet move to increase eligibility for the program.
Both companies, for example, stand to benefit from expansion in Pennsylvania, which is on track extend coverage to about 500,000 more residents beginning Jan. 1.
Roughly 19% of CHS' uninsured patients who would be eligible for Medicaid under the higher eligibility threshold, Smith said, reside in Pennsylvania, Utah (which is in talks with the CMS) and four other states that the company thinks could expand Medicaid next year: Indiana, Missouri, Tennessee and Wyoming.
“As you know, today is Election Day and we're hoping governors and state legislatures in non-expansion states will strongly consider the positive impacts of expanding Medicaid,” Smith said.
Follow Melanie Evans on Twitter: @MHmevans
