Last updated: July 10,
2012 9:13 pm
US hospitals face financial problems
By Stephanie Kirchgaessner in
Washington
Hospitals in some US states are facing a potential financial crisis after a
string of Republican governors rejected a provision of President Barack Obamafs
healthcare law that would have expanded their number of insured patients.
The governors of Texas, Florida, Louisiana and South Carolina, among others,
have announced they will not accept federal funds to increase their state-run
Medicaid programmes, which provides health services to the poor, because they
are staunchly opposed to the
administrationfs Affordable Care Act .
In announcing his decision on Monday, Rick Perry, the conservative Republican
governor of Texas, said those provisions of the law represented gbrazen
intrusions in to the sovereignty of the stateh.
The development spells bad news for roughly 4m uninsured people – the working
poor, as some analysts have defined them – who would have been eligible for
insurance in those states. It is also devastating for hospitals who are legally
obliged to treat those patients and take a hit to their bottom line whenever one
walks through their doors.
In 2010, the hospital industry took a gamble on the ACA. They backed the
presidentfs sweeping law and agreed to accept $155bn in cuts in government
reimbursements over 10 years to help to pay for it.
In exchange, they were promised tens of millions of additional insured
patients in the healthcare system who would no longer turn to hospital emergency
rooms as a destination of last resort for free health services.
gIt was the leading, if not the only, reason hospitals made the deal with the
administration to exchange cuts for coverage,hsays Sheryl Skolnick, co-head of
research at the CRT Capital Group.
The
Supreme Court last month broadly upheld the constitutionality of the ACA
provisions. But it said states had the right to opt out of the broad Medicaid
expansion outlined by the law.
Under the ACA, the federal government promised to pay for 100 per cent of the
cost of expanding state Medicaid programmes to uninsured adults with incomes of
up to 133 per cent of the federal poverty line – or about 16m new patients
nationwide – for three years. After that time, the states would have to pay for
up to 7 per cent of the cost of the expanded programme, while the federal
government would pay for the rest.
The state governors that have been at the forefront of the move to say gnoh
to Medicaid expansion are the same states with the highest number of uninsured
patients, including Florida and Texas.
For now, hospitals are still grappling with the stark new reality that they
may have to accept the deep cuts agreed under the law, but will not see the
benefit of more insured patients in certain states.
Some analysts predict that hospitals will be using their lobbying clout in
those Republican states to try to convince state legislatures to accept the
Medicaid expansion or take other actions to increase coverage.
They are also looking at other options. Jennifer Schleman of the American
Hospital Association says Congress may have to pass a new law to grevisith the
cuts that were agreed.
gThe Supreme Court decision is still fresh, so right now there are more
questions than answers,h she says.
The Texas Hospital Association, which says hospitals in the state paid for
$4.6bn in uncompensated care in 2010, said it wanted to see the state adopt its
own health insurance exchange and use subsidies to help insure the very
poor.
John Hawkins, the THAfs senior vice-president of government relations, says:
gAt the end of the day, we need coverage expansion to make the commitment for
the payment cuts to work.h
For now, the White House is suggesting that the political pressure that will
come down on governors who are rejecting a federally funded Medicaid expansion
in their states will be too much to bear, and that they will eventually be
forced to accept the taxpayer funds.
That relief cannot come soon enough for the hospital industry.
Ms Skolnick adds: gIn some states, those hospital associations will scream
bloody murder. There will be plenty of political pressure, but I am rather
cynical and think it is not going to matter.h
Copyright The
Financial Times Limited 2012.