Healthcare Legislation Project Paper : Disproportionate Share Hospital Payment Reduction Essay

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

In March 2010, one of the most controversial bills in modern history was signed into law by President Barack Obama. The Patient Protection and Affordable Care Act expanded the 1965 bill passed under President Johnson that created Medicare and Medicaid (“LBJ Presidential Library,” 2015). While the Affordable Care Act, or “Obamacare” as it has been dubbed by the media, has many components, the focus here is the expansion of Medicaid. Obamacare sought to expand Medicaid to cover those who earn too much to qualify for traditional Medicaid, but not enough to afford employer-provided health care. These people are said to be in the “coverage gap” (“Obamacare Medicaid expansion,” 2015). While only 32 states have adopted Obamacare, we should advance a policy encouraging the remaining states to expand existing coverage by extending the period of federal government cost-sharing an additional five years. Doing so would give states previously refusing the cost sharing a second chance to opt-in. This expansion would save money for the states from some of the rising cost of healthcare, and fulfill our moral duty to care for uninsured Americans.

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

The new law added to a per-existing hospital provider tax, which lawmakers love because it leverages federal matching funds that help pay for the state's Medicaid program. Critics objected to the increase because it added a new tax on health insurance.

These proposals often focus on using hospital DSH payments to expand coverage rather than using these sums to make payments to hospitals, using savings from reductions in other programs, or proposing new revenues (Holahan et al., 1995). The goal is to expand coverage at small new costs to the government (Holahan et al., 1995). The key features of

In order to more fully delve into this issue, this literature review will be focusing on three main areas of study as it applies to the topic of Medicare/Medicaid reimbursement and its relation to the Affordable Care Act. These areas of focus will include

Medicaid initially established that each state is responsible for designing their medical costs to pay medical care for the poor. Also, Medicaid created as a voluntary program for each state; they have to have the choice to participate. For one thing, because of the rising costs of healthcare, it has been difficult to bring Medicaid recipients into the “mainstream” of United States (U.S.) medical care. Donald R. Barr notes, “between 1975 and 1989, the cost of the Medicaid program increased by an average of 11.9 percent per year before adjusting for inflation” (172). The rising costs of healthcare are necessary for each state to determine if it is beneficial for them to participate in the Medicaid program. As the government level of payment is determined by each state economic condition. For instance, a state with lower per capita income will receive more government funding. A state with higher per capita income receives less reimbursement for program costs. Therefore, on December 31, 2010, many states continued to experience budget cuts. As a result on August 2010, Congress increased reimbursement rates through June 2011.

The goal of this policy brief is to support Alabama’s current decision to continue Medicaid Primary Care Parity, as first enacted by congress in 2010 to all states under section 1202 of the Affordable Care Act (ACA). However, as Alabama is facing budget cuts to its Medicaid services, supporting the “Ensuring Access to Primary Care for Women and Children Act” will extend federally funded Medicaid primary care parity without harming the state budget and negate the consequences of limiting Medicaid enrollee access and benefits. The federal government proposed to pay 100% of Medicaid services mandated under section 1202, from 2013 to 2014, which has since expired in December 2014. This program requires certain primary care services to be reimbursed at higher rates equivalent to those rates paid by Medicare for equivalent primary care services. Limited provider participation, limited Medicaid beneficiary access & decreased enrollment of physicians, physician assistants (PAs) and nurse practitioners (NPs) into primary care can be improved through this monetary incentive.

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

On February 16th, Speaker Paul Ryan, several House committee members, and Secretary Tom Price presented their outline for the plan set to replace the Affordable Care Act that would rely heavily on tax credits, yet according to The New York Times, would also drastically change the future of state Medicaid programs. According to Five Thirty Eight, Obamacare strived to expand Medicaid to all adults with incomes below 138 percent of the poverty level. This meant adding more than seventy million people to a program that already accounts for more than a quarter of all state budgets combined and half of all federal money that is routed to states. Republicans hope to cap and lower these costs by entirely changing the purpose of Medicaid, a Great Society

Ozark Medical Center (OMC) in West Plains, Missouri is one of them. It is considered a Disproportionate Share Hospital or ‘DSH’ and provides charity care. As Jennifer Davidson describes it in her Health and Wealth Update story on KSMU, “Charity care is healthcare that isn’t paid for, usually because the patient doesn’t have money or insurance” (p.1). Today the DSH designated hospitals do not receive the same amount of federal funds (DSH payments) they did before the ACA from 2010 was enacted. A supreme court decision in 2012 ruled the forced Medicaid expansion, which was included in the ACA, unconstitutional for all states and as a result the expansion is now an option for the states. However, Jennifer Davidson explains that when the remaining parts of the ACA were passed, “it included a 75 percent cut in those DSH payments. That’s because another part – the Medicaid expansion part – was supposed to make up for that reduction. So: more people covered by Medicaid, less charity care – and less need for DSH payments” (p.1). There are also cuts in the ACA to Medicare payments, which in addition to the reduced DSH payments could affect a hospitals finances by a large percentage. In Jennifer Davidson’s story, Ozarks Medical Center’s CEO David Zechman explained that “OMC could see a 60% reduction in its bottom line if Medicaid doesn’t get expanded”. OMC is not the only small rural hospital in Missouri which sees

The first piece of legislation (one legislation I discussion 2 pieces of that) discuss is section 101 part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a bipartisan legislation signed into law on April 16, 2015. This law was created to replace the current law in that time Medicare reimbursement schedule with, the revolutionary idea of new program supposed directed focus on the quality, value and accountability of the national health care program. The CMS describe MACRA as a modern system new payment framework, supposed rewarded the national health care providers to obtain the better care instead of more service, looking for value over volume. The information’s observed in the interview provides consistent points

Other areas of great concern to policy makers are poor coordinated funding by both Medicaid and Medicare, need to enact laws that will alleviate poverty of beneficiaries,

This is forcing the doctors to no longer accept certain insurance companies such as medicaid because they aren’t being reimbursed for the services they’re providing to the consumers that are using medicaid. One doctor, Dr. Martha Boone in Atlanta, Georgia, said that she would have to see 20 patients an hour in order to make any reimbursement from medicaid. She said that medicaid paid none of their bills coming from her office for 18 months and when her office sent registered letters to Medicaid to see what the problem was they said it was a computer error and still didn’t reimburse her office (Heritage, 2010). Because most doctors don’t receive money from Medicaid, most of them don’t accept it. “Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.” (Connelly, 2009). This forces the Medicaid consumers to go to the emergency room when they need help since normal doctors rarely take their insurance. Dr. Lloyd Krieger says that the undoing of this healthcare bill is, “an urgent necessity.” because it is, “doing great damage even years before it’s individual mandates and other controls kick in.” (Krieger, 2011).