Has the ACA Put Public Well-Being at Risk?

Over the past few weeks, we have been exploring some of the arguments for and against the ACA, and the possible victories and consequences of its implementation. Today, we’re looking at what some experts say is the biggest victim of the ACA ruling; safety-net hospitals.

These facilities – defined as a hospital that “provides a significant level of care to low-income, uninsured, and vulnerable populations” – will soon be facing the full brunt of a financially-poor populace. One rule in the ACA allowed states to individually choose whether or not to expand Medicaid to their populations. Already, thirty states are threatening to reject Medicaid expansion, and some experts worry that other states will follow their example.

What makes this such a huge problem?

Safety-net hospitals rely on the Medicaid Disproportionate Share Hospital Program (DSH) to care for their patients. The program provides financial assistance to hospitals that serve large numbers of uninsured or low-income patients. Part of the ACA’s budget-cutting plan involves the steady decrease of payments made to the DSH program. That means that already struggling safety-net hospitals will be serving masses of people, with even less funding than they have now.

Bruce Siegel, President and CEO of the National Association of Public Hospitals and Health Systems, believes that this “double-whammy” of ACA rules represents a grievous oversight by the Supreme Court.

The question for us is, how can (the federal government) make the Medicaid expansion optional but leave these enormous disproportionate share fund (DSH) cuts that are in the Affordable Care Act. The ACA cuts the DSH funds by about half, and though it's phased in, you're looking at cuts of over $5 billion a year when the cuts are maxed...$5.6 billion by 2019 per year. Safety net hospitals depend on that money to care for uninsured patients and were banking on the coverage expansion to make up for that loss of money.

So what we're seeing now, and if you cut the DSH, it will be a disaster, a disaster for the safety net and a disaster for patients. You can have a safety net for public hospitals or you can have Medicaid coverage. One or the other. But what's happening is that we are walking away from both.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Are Patients Uninformed on Healthcare?

In past blogs, we’ve touched on the concept that most consumers are simply uneducated when it comes to healthcare. Health and wellness are considered “professional” territory, and most consumers probably feel that they lack the ability to understand the nuts and bolts of our healthcare system. The result of those assumptions, it seems, are disastrous.

The Affordable Care Act is possibly the largest news story of the year, and is certainly the largest in the health sector. It should come as a surprise then, that a combined 45% of consumers do not know that SCOTUS upheld the act. 30% didn’t know which way the ruling went, and a more shocking 15% believed that President Obama’s reform had been overturned.

This is a major problem. Understanding the ACA could be vital to the wellbeing of many of these consumers. Many experts feel that it is the responsibility of health workers to educate the populace. FierceHealthcare interviewed Shawn Gremminger, vice president of Legislative Affairs at NAPHHS, who said, “Since hospitals and their employees are often considered "neutral informers" about the state of healthcare, they have an opportunity to let people know what the ruling means and what it doesn't…”

What do you think? Should hospitals be educating consumers on healthcare? If not, who is responsible for it?

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

More Experts Stand In Favor of ACA

For the past two weeks, we’ve been discussing the recent acceptance of President Obama’s Affordable Care Act by the Supreme Court of the United States. The Supreme Court’s decision has been seen as controversial by some, and borderline offensive by others. Last week, we looked at some of the reasons that may state legislators are opposed to this legislation. This week, we’ll explore some of the higher-ups in Washington that are urging legislators and state representatives to end their repeal efforts.

…U.S. Health & Human Services Secretary Kathleen Sebelius said that abolishing the Patient Protection and Affordable Care Act would be disastrous, HealthLeaders Media reported.

"[T]he House of Representatives is preparing to hold another vote--their 31st vote--on repealing the Affordable Care Act. For millions of seniors and people with disabilities who have seen the impact of these benefits in their own lives, the consequences of repeal would be devastating," Sebelius said in a press briefing.

Sebelius calls for a return to reason, pointing out that “Scrapping the legislation would not only deny coverage to 32 million Americans but also add a trillion to the deficit in the next 10 years…”

Of more concern to top health officials, the House effort has been to repeal the law, not to replace it. Officials worry that removing the ACA without any other back up strategy would result in at least another year without a healthcare solution.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Are We Celebrating Healthcare Too Early?

Last week, the news broke that the Supreme Court of theUnites States (SCOTUS) upheld the individual mandate, and the constitutionality of the Affordable Care Act (ACA). Initially, health experts were happy to see advances being made in improving our country’s health care systems. Now, many of those experts are beginning to question just how large that victory was.

Fierce Healthcare editor Karen Cheung has been writing about healthcare for a long time, and in her column this week, she expresses some reservations about President Obama’s victory.

 Even though many patients and providers breathed a sigh of relief last week when the Supreme Court ruled that the Affordable Care Act is constitutional, they're still keeping their fingers crossed when it comes to overuse and overcrowding in the emergency room.

According to the American College of Emergency Physicians, ER visits will continue to rise, regardless of the ruling… With half of health leaders reporting that their emergency departments are overcrowded as is and overcrowding growing twice as fast as ER visits, it's grim news for hospitals, still struggling with the ever-growing ER problem.

Cheung worries that the ACA is asking emergency rooms to do more with less, and that reduced staffing and resources will add to the overcrowding issue. The Washington Post reports on a similar problem, in which the law will likely cause negative side effects in other, similar companies.

Many [insurers] may see profits margins shrink because they will no longer be able to deny individuals with pre-existing conditions. At the same time, the law limits how much insurers can raise their rates — if they go over a certain percentage, they’ll have to rebate consumers…

… Mom-and-pop nursing homes and other small long-term care facilities may struggle to stay independent because they won’t be able to afford the costs of complying with new regulations. “We’ll see an increasing consolidation of the long-term care industry, especially as baby boomers get older and start to require care,” said Michael Loucks, a health care attorney at Skadden Arps.

What do you think? Do the pros out-weigh the cons? Have we overestimated the help that the ACA can bring? Tell us in the comments!

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.