Some hospital executives in states with senators critical to passing a healthcare reform bill have made their opposition to the legislation known and they're keeping a laser focus on Medicaid expansion.
Doug Bentz, CEO of Roane General Hospital in Spencer, W.Va., said he met with Republican Sen. Shelly Moore Capito in person about 10 days ago, along with about a dozen other hospital executives, and said he'd be on a conference call with her again Thursday.
Bentz said he's known Capito for 15 years. "She's got to be under a tremendous amount of pressure" to vote yes, he said. He added: "I've got confidence in her. There's nothing about her actions in the past that would lead her to abandon the Medicaid expansion population."
Both the Senate and House bills propose larger overhauls to Medicaid and what the Affordable Care Act did to promote expansion for newly eligible adults than repealing Obamacare or many of its provisions.
That's why Bentz and his colleagues are going for a full-court press on lawmakers who could make or break the proposed legislation.
Republicans cannot count on a single Democratic vote, so Senate Majority leader Mitch McConnell can afford to lose only two Republicans and still pass the bill. Some provisions in the original draft seemed targeted to swaying moderates—such as exempting Alaska from a provision designed to lower federal Medicaid dollars in high-spending states.
But McConnell is trying to add more to nail down the majority. A White House aide told Axios the bill could pass after McConnell "bribes" these senators with promises of funding some of their pet projects.
Bentz, for one, said he only talked to Capito about the importance of the Medicaid expanded population. He said it would be wrong to say it's vital to the hospital's continued success. Instead, he said, "It's vital to our continued existence." Before the expansion, Bentz' critical-access hospital and its outpatient primary-care practices weren't paid for what they did 12% of the time. That has fallen to 1.5%.
He said a longer-phase out of the enhanced match as currently proposed in the Senate bill is not enough. Nor is $45 billion in opiate addiction funding over 10 years, an increase of $43 billion from the original draft.
In fiscal 2015, spending on Medicaid expansion was nearly $58 billion, nearly all of it by the federal government.
And West Virginia might not be able to make up the difference between funding 10% of its expansion costs and 26% after the enhanced match ended.
"I think they would want to, but I'm not sure they can," Bentz said. He said the state just had a "very ugly budget process to fill in the holes this year."
West Virginia has the second-highest federal Medicaid match in the country, because of the low incomes earned there.
The majority of Roane General's beds are nursing home beds—35 of the 60—but Bentz hasn't even brought up what a per-capita cap with a growth rate linked to inflation would do to the facility. He said 90% to 95% of the long-term-care beds are covered by Medicaid.
In Toledo, Ohio, Kevin Webb, chief acute and post-acute care officer at ProMedica, has not met with Sen. Rob Portman, the state's Republican senator, but has emailed him about repeal and replace.
"The Senate version calls for gradually rolling back the Medicaid expansion over a number of years, and I think that's a big mistake," he said.
About 700,000 adults became eligible for Medicaid in Ohio through the expansion. Although Webb pointed to Ohio's opiate epidemic—the state has the most fatal overdoses in the country—as a reason to keep the enhanced match for the expansion, he said more funding for treatment would not be an adequate substitute.
"I think that's just shooting your left foot to save your right foot," he said. "It seems crazy to me."
Webb said Portman responded to his email, saying "he's obviously concerned about people losing coverage."
Mercy Health, which has 23 hospitals across Ohio and Kentucky, declined to say whether anyone from the Catholic system had lobbied Portman on the bill, in person or otherwise. Instead, a spokeswoman said: "Mercy Health leaders are actively engaged in discussions with political and religious leaders, and that will continue." She said there is a common message for both Kentucky and Ohio politicians.
McConnell represents Kentucky. So does Rand Paul, who says he can't support the bill because it doesn't do enough to eliminate Obamacare provisions.
In Tennessee, where Republican Sen. Bob Corker has said he has problems with the bill, a Maury Regional Medical Center executive emailed him and fellow Republican Sen. Lamar Alexander, but the hospital did not disclose what was said.
Kansas Republican Jerry Moran is another senator who has said he can't support the first draft of the Senate bill, but it's not clear whether he thinks it's too generous or not generous enough compared with current law.
"I remain committed to working with my colleagues and continuing conversations with patients and providers in Kansas to find a path forward that truly repeals and replaces Obamacare with a plan that makes certain Kansans will have access to more affordable and better quality healthcare," he said Tuesday.
Goodland Regional Hospital CEO Bill Widener said he hasn't met with Moran on the healthcare bill, but if he did, he would tell him the proposed per-capita cap for Medicaid "would be a disaster for rural health."
Goodland Regional is a 25-bed rural critical access hospital. He said roughly 20% of Goodland's revenue comes from Medicaid. Uncollectable bills from patients is equal to about 5% of services, he said. Kansas did not expand Medicaid to adults without children at home, and Widener said he wishes it had.
If reimbursement falls as states try to manage cost-shifting from the federal government under a per-capita cap, Widener is worried more doctors will refuse to see Medicaid patients, which will only mean more people will enter the healthcare system at the ER.