Senate Finance Chairman Chuck Grassley (R-Iowa) said Thursday that Congress won't reform the Medicaid disproportionate-share formula this year as anticipated, but they will likely temporarily delay cuts to the program.
Grassley said he expects the delay of $4 billion in DSH cuts for fiscal 2020 to be extended in an end-of-year appropriations fight. Congress has not yet passed a patch to avert a government shutdown on Nov. 22, but they are expected to punt a funding fight to December.
In return for the payment cut delay, Grassley said he wants hospitals to agree to disclose all public funding they receive to the CMS and state Medicaid programs, including non-DSH supplemental payments at the facility level. He argued the disclosure should not be controversial, as hospitals already have the information.
"They appreciate what I'm doing on drug pricing. They appreciate what I'm doing on 340B. Since we agree on everything else, and I agree with them on 90% of the stuff they want, why are they fighting us on just getting a little bit of information they have already accumulated?" Grassley said. "And why do they think we are stupid enough to think it's a big burden for them when it's already in their computer?"
America's Essential Hospitals, which represents safety-net hospitals, said their members rely on DSH payments and work to steward the funding well.
"We've always been willing to talk with Congress about how to ensure appropriate use of federal funds, and we continue to welcome that opportunity," said Carlos Jackson, vice president of legislative affairs for America's Essential Hospitals.
The American Hospital Association and the Federation of American Hospitals did not respond to requests for comment on Grassley's public funding transparency request.
Hospital groups agreed to DSH payment cuts in the Affordable Care Act, but have successfully lobbied to delay the cuts so far.
Several lawmakers have pushed for reforms to how Medicaid DSH payments are distributed, but Grassley said the efforts are dead this year.
"There ought to be some reforms in DSH, but we won't be able to do that. So the only thing is that we want the information hospitals have so we can better analyze DSH," Grassley said.
Sen. Marco Rubio (R-Fla.), who released a discussion draft in December of a plan to redistribute Medicaid DSH payments, said making changes is difficult because the current distribution has been in place for nearly 30 years.
"There are winners and losers in that reorientation, and there are people that would not do as well are going to fight like crazy to keep things the way they are," Rubio said.
The current payment formula skews funding significantly for some states over others. Both Grassley's and Rubio's home states lose under the current structure. Grassley called the payment system "unfair, grossly outdated, and easily abused" in an April statement.
The House is working on its own policy to address cuts to DSH payments, but House Energy & Commerce Committee Chairman Frank Pallone (D-N.J.) said Thursday that he had no updates on his progress addressing the issue. Energy & Commerce passed a bill in July that would repeal the cuts for fiscal 2020 and 2021 and reduce the scheduled cut of $8 billion in 2022 by half.