Congress will soon decide how to keep the federal government running past the Jan. 19 end of its temporary funding. When it takes that next step, it must not leave behind millions of low-income working people and others who depend on the nation's safety-net hospitals.
These hospitals—the backbone of the nation's healthcare safety net—depend on a patchwork of funding to keep their doors open, including targeted Medicaid support called disproportionate-share hospital, or DSH, payments.
As the name suggests, this funding goes to hospitals that provide a disproportionate share of uncompensated care—hospitals like mine, the University of Texas Medical Branch (UTMB Health), in Galveston. Medicaid DSH is vital to essential hospitals: without it, their average 3.2% margin would swing to a nearly 4% loss.
The Affordable Care Act mandated deep cuts to Medicaid DSH, based on expected gains in coverage. But various factors—notably, a U.S. Supreme Court decision making the ACA's Medicaid expansion optional—upset this careful balance. Now, we have 7 million more uninsured Americans than projected, and that number will likely grow sharply with the recent repeal of the ACA's individual mandate. Yet the DSH cuts remain, baked into the law with no mechanism to respond to fluctuating coverage levels.
Congress recognized this disparity and delayed the DSH cuts in three strongly bipartisan votes since 2013. But those delays ended last fall, with the Oct. 1 start of the current federal fiscal year and no additional congressional relief. The House of Representatives did pass a two-year DSH cut delay, but Congress ultimately left it out of the temporary funding bill.
So now we look to Jan. 19 and the next funding measure. The need for congressional action is urgent: States had some breathing room before the brunt of DSH cuts hit, but that window closed on Jan. 1. It won't be long before hospitals that provide a safety net for low-income and uninsured patients begin making difficult decisions to reduce costs in the face of $2 billion in DSH cuts.
Those decisions will affect more than vulnerable patients. The same hospitals that, by their mission, care for people who face financial hardships also provide vital services to entire communities: Level I trauma care, neonatal intensive care and disaster response, for example. These hospitals also operate extensive outpatient networks, making care available where and when people need it and keeping people out of emergency rooms and at less costly sites of care.
All this is also at risk and the threat hits close to home here in Galveston. Having just endured a terrible hurricane season, residents of Galveston and surrounding areas know well the vital role UTMB Health plays when disaster strikes.
Bringing more than 40 inches of rain over four days, Hurricane Harvey devastated southeast Texas last August. Through it all, UTMB Health remained resilient and strong. Our staff delivered exceptional care at our three campuses, many working five or six days in a row without going home. Food services employees braved floodwaters to make it to work so they could serve meals to patients, families, faculty and staff. All our hospitals and emergency departments remained open during the storm and provided needed aid to their communities. We even accepted critically ill patients from other southeast Texas hospitals closed by floodwaters.
Safety-net hospitals across the country have equally compelling stories about serving communities in times of need. That ability to respond quickly and effectively, to remain resilient and strong under trying circumstances, is what we put at risk when we chip away at funding central to our mission, such as DSH support.
Medicaid DSH helps keep the doors open at hospitals for people who have nowhere else to turn and for communities that have no other options for lifesaving care. DSH cuts threaten patients and community stability, and we must not allow them to continue. With a delay, we can work together on sustainable, long-term solutions to uncompensated-care costs that protect patients and taxpayers.
Donna Sollenberger is board chair of America's Essential Hospitals and executive vice president and CEO of the University of Texas Medical Branch Health System, Galveston.