ACA and Safety-Net Hospitals

Cuts in hospital subsidies threaten safety-net care, By Sabrina Tavernise, November 8, 2013, New York Times: “The uninsured pour into Memorial Health hospital here: the waitress with cancer in her voice box who for two years assumed she just had a sore throat. The unemployed diabetic with a wound stretching the length of her shin. The construction worker who could no longer breathe on his own after weeks of untreated asthma attacks and had to be put on a respirator. Many of these patients were expected to gain health coverage under the Affordable Care Act through a major expansion of Medicaid, the medical insurance program for the poor. But after the Supreme Court in 2012 gave states the right to opt out, Georgia, like about half the states, almost all of them Republican-led, refused to broaden the program…”

Medicaid Patients and Hospital Readmissions

NC study cut hospital readmissions among state’s sickest, poorest patients, By John Murawski, August 7, 2013, News and Observer: “A North Carolina study on reducing costly hospital visits cut readmissions by 20 percent among the sickest and poorest patients who are most prone to relying on hospitals for their medical care. The project, believed to be the largest of its kind in the nation, was conducted by Community Care of North Carolina, a Raleigh-based physician-led program that focuses on helping poor people get health care and avoid hospitalization. It involved some 800 nurses and social workers doing intensive follow-ups with Medicaid patients. They sometimes shadowed patients for months to make sure they took their medications, kept their doctor’s appointments and followed all instructions…”

Medicaid Coverage and Prison Inmates

States missing out on millions in Medicaid for prisoners, By Christine Vestal, June 25, 2013, Stateline: “Only a dozen states have taken advantage of a long-standing option to stick the federal government with at least half the cost of hospitalizations and nursing home stays of state prison inmates. The other states have left tens of millions of federal dollars on the table, either because they didn’t know about a federal rule dating to 1997 or they were unable to write the laws and administrative processes to take advantage of it. States and localities have a constitutional obligation to provide adequate health care to prisoners, and they must pay for it out of their own budgets. However, a 1997 ruling says that care provided to inmates beyond the walls of the prison qualifies for Medicaid reimbursement if the prisoner is Medicaid eligible. The federal government then pays 50 percent to 84 percent of Medicaid costs…”

Health Insurance Coverage and Access to Care

Costs of expanding health coverage reduced by fewer hospital stays, study shows, By Guy Boulton, June 3, 2013, Milwaukee Journal Sentinel: “A state health insurance program that provided improved access to care for adults with very low incomes in Milwaukee County sharply reduced hospitalizations, suggesting that the cost of expanding coverage could be partially offset by the money saved from fewer high-cost hospital stays, according to a study led by researchers at the University of Wisconsin-Madison. The study, which was published Monday in the policy journal Health Affairs, found an increase in visits to clinics and emergency departments, but a 59% drop in hospitalizations and a 48% drop in preventable hospitalizations. The study supports the idea that if people, particularly those with chronic illnesses, have better access to care, they may be able to manage their health better, said Thomas DeLeire, a professor of public affairs and economics and director of the La Follette School of Public Affairs at UW-Madison…”

States and Medicaid Expansion

  • Hospitals lobby hard for Medicaid expansion, By Michael Ollove, April 17, 2013, Stateline: “With billions of dollars at stake, hospitals are lobbying hard for Medicaid expansion in Columbus, Tallahassee and other state capitals where state legislators oppose the extension of the program to some 17 million Americans. Hospital associations have paid for television and newspaper ads, organized rallies, and choreographed legislative testimony in support of the Medicaid expansion, which is part of the Affordable Care Act. They also have united disparate groups which are used to being on opposite sides of legislative debates. In Columbus, for example, Ohio Right to Life and Planned Parenthood Advocates of Ohio are working side-by-side to persuade state lawmakers to approve the expansion. Both groups say they want to make health insurance available to the poor…”
  • Arkansas OKs compromise plan to use federal Medicaid expansion funds for private insurance, Associated Press, April 17, 2013, Washington Post: “Arkansas’ plan to use federal money to buy private insurance for low-income residents won final approval from state lawmakers Wednesday, endorsing a model that several other states are eyeing as a possible alternative to expanding Medicaid. The Republican-controlled Legislature narrowly reached the three-fourths majority needed to pass the proposal, which was a compromise reached between leading GOP lawmakers and Democratic Gov. Mike Beebe…”
  • New Jersey Medicaid expansion seen as on schedule, By Chris Mondics, April 17, 2013, Philadelphia Inquirer: “New Jersey is gearing up for a huge expansion of its Medicaid health-care plan for the poor and, despite uncertainty over federal eligibility requirements, new enrollees are expected to begin receiving services by the Jan. 1 deadline, Human Services Commissioner Jennifer Velez said Tuesday. Velez, who testified before the Assembly Budget Committee on her department’s proposed $15 billion budget for the fiscal year that begins July 1, said she expected about 300,000 new Medicaid enrollees to be added to the 1.3 million who receive care under the program. The state will get slightly more than $1 billion from the federal government under the Affordable Care Act to pay for the expansion…”
  • Legislator unveils another approach to insure low-income Texans, by Chuck Lindell, April 16, 2013, Austin American-Statesman: “With staunch Republican opposition leaving Medicaid expansion on life support, a GOP lawmaker is pushing legislation to spend billions of government dollars to purchase private-market health insurance for the state’s poorest citizens. State Rep. John Zerwas, R-Simonton, calls it the ‘Texas Solution.’ Instead of adding up to 1.5 million uninsured Texans to Medicaid under the Affordable Care Act, the Zerwas plan would extend coverage by plowing the money into private insurance policies, similar to an arrangement Arkansas is working out with the federal government, he said…”
  • House wants waiver on Medicaid for now, By Jim Siegel, April 18, 2013, Columbus Dispatch: “In the latest chapter of the Medicaid expansion debate in Ohio, the House tonight is expected to ask Kasich administration to seek a waiver from the federal government and return with a new proposal this fall. The amendment will be part of final changes the House will make before giving final passage to the two-year, $61.5 billion budget…”
  • Medicaid expansion debate suspended, By JoAnne Young, April 18, 2013, Lincoln Journal Star: “Talk isn’t cheap. It’s a valuable commodity when the clock is ticking down on the long session of the Legislature. On Tuesday and Wednesday, the Legislature spent a lot of words — 10 hours and 20 minutes worth — on Medicaid expansion. But it went away empty-handed, without even a vote on an amendment on the bill (LB577)…”

US Health Care System

This election, a stark choice in health care, By Abby Goodnough and Robert Pear, October 10, 2012, New York Times: “Joyce Beck, who runs a small hospital and network of medical clinics in rural Nebraska, is reluctant to plan for the future until voters decide between President Obama and Mitt Romney. The candidates’ sharply divergent proposals for Medicare, Medicaid and coverage of the uninsured have created too much uncertainty, she explained. ‘We are all on hold, waiting to see what the election brings,’ said Ms. Beck, chief executive of Thayer County Health Services in Hebron, Neb. When Americans go to the polls next month, they will cast a vote not just for president but for one of two profoundly different visions for the future of the country’s health care system…”

States and Medicaid Expansion

  • FSSA: Indiana Medicaid costs to grow under health law, By Eric Bradner, September 18, 2012, Evansville Courier and Press: “Even if Indiana policymakers opt to turn down the Medicaid expansion envisioned in the federal health care law, the program’s enrollment is expected to grow in the coming years. It’s because of a ‘woodwork effect’ that the actuary for Indiana’s Family and Social Services Administration is projecting. It means that due to the law’s individual mandate that all Americans have health insurance, those who are eligible for Medicaid but aren’t currently signed up will, as the expression goes, come out of the woodwork. The cost of such an effect, with up to 123,000 Hoosiers potentially becoming part of it, would be about $600 million over a seven-year period, according to a new round of estimates that the actuary, Milliman, Inc., provided Tuesday…”
  • Utah doctors give qualified nod to Medicaid expansion, By Kirsten Stewart, September 17, 2012, Salt Lake Tribune: “Utah doctors support expanding Medicaid but with a few caveats. After hours of contentious debate Saturday over a provision in federal health reform that would expand the health safety net to cover more of the nation’s poor, the Utah Medical Association’s (UMA) House of Delegates approved this carefully parsed statement: ‘When health care reform measures are under consideration by the governor and Legislature, the UMA will support such measures as will improve our patients’ access to care, including the expansion of Medicaid coverage if that is the best way to provide coverage to all Utahns.’ It seems a tepid endorsement for a policy that would insure a third of the state’s uninsured, about 105,000 people. But advocates for the expansion, such as Ray Ward, a family physician in Bountiful, say it’s the best they could hope for given the circumstances…”
  • Hospitals may lose money if Medicaid not expanded, Associated Press, September 17, 2012, Kearney Hub: “The University of Nebraska Medical Center’s two hospitals in Omaha stand to lose millions of dollars in federal aid under the new federal health care law unless the state expands Medicaid coverage, and administrators said those cuts could mean problems for academic programs that rely on the hospitals for revenue.  Administrators said the law will eliminate federal payments to the Nebraska Medical Center and the Children’s Hospital and Medical Center. Both qualify for special aid because they serve as safety-net hospitals for patients who are on Medicaid or uninsured, said Cory Shaw, the chief executive officer of UNMC Physicians. Medicaid is a federal health program administered by states covers low-income adults and children as well as people with certain disabilities…”

Medicaid Expansion – Georgia, Iowa

  • Deal rejects expansion of Medicaid, By Daniel Malloy, August 28, 2012, Atlanta Journal-Constitution: “Gov. Nathan Deal said Tuesday that he will not expand the Medicaid program under the federal Affordable Care Act – which would have provided an estimated 650,000 low-income Georgians with health coverage – because it would be too expensive. Deal had said that he would wait until after the presidential election to decide, but during an interview with The Atlanta Journal-Constitution, 11 Alive and Politico at the Republican National Convention, Deal was firm that he will not take federal money to expand the state-based health insurance program for the poor in 2014…”
  • Hospitals urge state to expand Medicaid, By Tony Leys, August 28, 2012, Des Moines Register: “Iowa hospital executives want the state to accept hundreds of millions of dollars in extra federal Medicaid money under the national health reform program. Gov. Terry Branstad plans to decline the money, which would expand Medicaid to cover about 150,000 poor Iowa adults. Branstad is skeptical that the federal government can afford to keep its promise to pay at least 90 percent of the cost. The Iowa Hospital Association board recently voted unanimously to support expansion of Medicaid, which it termed a ‘historic opportunity to significantly address the plight of uninsured Iowans.’ Association members plan to aggressively lobby legislators on the subject…”

State Medicaid Programs – New York, Utah

  • New York’s model for Medicaid managed care, By Christopher Flavelle, August 23, 2012, Businessweek: “In February officials from the New York State Department of Health summoned senior executives from WellCare Health Plans (WCG) to a private meeting in Albany. Attendance was not optional. For the third straight year, WellCare, which covers 75,000 New York State Medicaid beneficiaries, had just received low marks for the quality of care it was delivering, a scorecard that includes doctor visits for children, diabetes treatment, and cancer screenings. In most large states, that would be unremarkable: Many Medicaid managed-care plans, especially those run by for-profit insurers, report below-average access to medical services with few consequences, according to a study conducted by Bloomberg Government…”
  • Utah Medicaid stops paying for hospital errors but data spotty, By Kirsten Stewart, August 23, 2012, Salt Lake Tribune: “Utah’s Medicaid program no longer pays hospitals to treat illnesses and injuries caused by poor care for patients, such as infections, on-site falls and surgeries on the wrong body part. Hospitals have had to report these ‘provider-preventable conditions’ to the Utah Department of Health since July 2011, a requirement of federal health reform. They’ve disclosed 17 to date, most of them infections. But precisely how much taxpayer money was saved isn’t known…”

States and Medicaid

  • Making $11,000 a year, but excluded from Medicaid, By Kelli Kennedy (AP), August 14, 2012, Atlanta Journal-Constitution: “Sandra Pico is poor, but not poor enough. She makes about $15,000 a year, supporting her daughter and unemployed husband. She thought she’d be able to get health insurance after the Supreme Court upheld President Barack Obama’s health care law. Then she heard that her own governor won’t agree to the federal plan to extend Medicaid coverage to people like her in two years. So she expects to remain uninsured, struggling to pay for her blood pressure medicine. ‘You fall through the cracks and there’s nothing you can do about it,’ said the 52-year-old home health aide. ‘It makes me feel like garbage, like the American dream, my dream in my homeland is not being accomplished.’ Many working parents like Pico are below the federal poverty line but don’t qualify for Medicaid, a decades-old state-federal insurance program. That’s especially true in states where conservative governors say they’ll reject the Medicaid expansion under Obama’s health law…”
  • Frequent Medicaid patient doctor visits no longer allowed, By Liz Freeman, August 13, 2012, Naples Daily News: “Medicaid patients with chronic health problems, be prepared: Frequent doctor visits are no longer allowed. Hospitals also are taking new hits from the state Medicaid program for the poor and disabled. Payments for ‘frequent flier’ patients to emergency room stops with the seventh visit in one year. The Florida Legislature approved the caps this past spring. The state Agency for Healthcare Administration recently notified hospitals and doctors of the changes that kicked in Aug. 1. The catch is a consumer watchdog group, Florida CHAIN, says it has asked the state for proof it has sought approval from the federal government to make the changes…”

Affordable Care Act and Safety-Net Hospitals

Hospitals fear cuts in aid for care to illegal immigrants, By Nina Bernstein, July 26, 2012, New York Times: “President Obama’s health care law is putting new strains on some of the nation’s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide. The federal government has been spending $20 billion annually to reimburse these hospitals – most in poor urban and rural areas – for treating more than their share of the uninsured, including illegal immigrants. The health care law will eventually cut that money in half, based on the premise that fewer people will lack insurance after the law takes effect. But the estimated 11 million people now living illegally in the United States are not covered by the health care law. Its sponsors, seeking to sidestep the contentious debate over immigration, excluded them from the law’s benefits…”

Safety Net Hospitals and Medicare Changes

Poorer hospitals may suffer from Medicare changes, By Genevra Pittman, July 16, 2012, Chicago Tribune: “Under upcoming changes in Medicare and Medicaid payment policies, hospitals largely treating the poor and uninsured may be hit extra hard if patients continue to rate their experiences there lower than at other hospitals, according to a new study. So-called safety-net hospitals take in a lot of patients on government insurance – which doesn’t pay as much for services as private insurance – or without any insurance at all, leaving them often under financial stress and struggling to stay open, researchers said. Under the Affordable Care Act, a small proportion of Medicare and Medicaid funding going to hospitals will be determined by performance measures, including how patients rate their experiences there. That’s not a bad idea in general, said Dr. Ashish Jha . . .”

Medicaid Patients and Emergency Care

  • Medicaid patients turn to hospitals for emergencies, not routine care, By Susan Heavey, July 11, 2012, Chicago Tribune: “Most people covered by government health insurance for the poor visit hospital emergency rooms for perceived emergencies, not for routine care, much like those with private insurance, according to a study released on Wednesday. Researchers said the study helps dispel the notion that poor patients are clogging hospitals for routine treatment – for a bad cold, for example – that others receive at lower cost in a clinic or at a doctor’s office. Patients on Medicaid – the insurance program for low-income people financed by federal and state governments – do visit emergency rooms at twice the rate of privately insured patients, said the study by the non-partisan Center for Studying Health Systems, reflecting ongoing challenges in finding alternative care…”
  • Study: Most Medicaid patients visit the ER for urgent, not routine, care, By Sarah Kliff, July 11, 2012, Washington Post: “Policymakers frequently say that Medicaid patients overuse the emergency room for routine care, citing it as a factor driving up health-care costs. But a new study says that the majority of Medicaid visits to the emergency room are for urgent or serious issues…”

Health Assistance Program

Needy patients get ‘prescriptions’ for food and shelter through volunteer program, By Sandra G. Boodman, June 18, 2012, Washington Post: “Treshawn Jones was desperate. Jobless for four months, she had burned through her meager savings, was running low on food for her two young children and barely scraping by on weekly unemployment checks of $307 that didn’t begin to cover her overdue $600 utility bill and monthly rent of $900. So in March, while at Children’s National Medical Center with her 2-year-old son, Jones asked a sympathetic staff member if she knew of any resources that could help her family. Within minutes, Jones was meeting with Shalesha Lake, a junior at the University of Maryland at College Park who volunteers for Health Leads, an innovative program that has operated at Children’s since 2001. Three months later, with guidance from Lake, the 35-year-old single mother had completed a free job training course offered by Byte Back, a nonprofit group that provides computer training to underserved District residents, obtained free food and clothes for her children, applied for utility and rental assistance. . .”

Medicaid Eligibility – Ohio

  • Medicaid access made easier, By Catherine Candisky, June 6, 2012, Columbus Dispatch: “Ohio will be the 18th state to make it easier for poor children and pregnant women to get on-the-spot access to tax-funded health care. Under a pilot program starting next week, a handful of community health clinics and hospitals, including Nationwide Children’s Hospital in Columbus, will be authorized to do a quick screening and immediately grant eligibility for 60 days in the state Medicaid program. State officials say they plan to expand so-called ‘presumptive eligibility’ to clinics and hospitals statewide in about six months…”
  • Ohio eases access for Medicaid-eligible patients, By Ann Sanner (AP), June 6, 2012, Coshocton Tribune: “State officials are hoping to more easily grant uninsured pregnant women and children in Ohio access to health care services under Medicaid, if they are likely to qualify for the program that provides coverage to the poor and disabled. A pilot program slated to start next week would allow certain health care providers in Ohio to presume the patient is eligible for Medicaid after an initial screening test. Children and expectant mothers would have to prove residency and provide other biographical details. The patients then could access the Medicaid-funded services immediately for 60 days while they apply for the program…”

Hospitals and Charity Care – Illinois

Legislation defines charity care for hospitals, By Peter Frost, May 29, 2012, Chicago Tribune: “Not-for-profit hospitals in Illinois facing the specter of paying millions in property taxes were granted a reprieve Tuesday when the state Senate passed legislation that will allow hospitals to apply a much broader definition for what qualifies as charity care. The legislation, embedded in a bill that seeks to raise about $700 million for the state’s underfunded Medicaid program through a $1-per-pack cigarette tax, sets a clear formula for how much free care and services hospitals must provide to qualify for tax breaks, ending nearly 10 years of wrangling on the issue. It requires that hospitals provide an equal or greater amount of free or discounted services to low-income patients each year than their annual estimated property tax liability to qualify for an exemption…”

Hospitals and Charity Care – Maine

Charity-care demands grow for hospitals, By Jessica Hall, May 6, 2012, Kennebec Journal: “Maine hospitals have doubled the amount of free care they provide over the past five years as the weak economy pushed more people out of work, and companies shifted an increasing amount of health care costs onto employees. ‘The economy is having a significant impact. As the economy continues to stay stagnant, companies are changing insurance. People are adjusting what insurance they carry and others have lost insurance,’ said Sue Hadiaris, vice president of planning and development at Southern Maine Medical Center in Biddeford. More scrutiny has been placed on free care as health care has become big business and top hospital executives in Maine fetch six-figure salaries. Hospitals vary in the types and amounts of free services they provide, as well as how they disseminate charity care information to their patients, advocates said…”

Charlotte Observer Series on Nonprofit Hospitals

Prognosis: Profits, Series homepage (Five-part series), Charlotte Observer:

  • Nonprofit hospitals thrive on profits, By Ames Alexander, Karen Garloch and Joseph Neff, April 21, 2012, Charlotte Observer: “Nonprofit hospitals in the Charlotte region are respected community institutions. They save lives, heal the sick and provide good jobs. At the same time, most of them are stockpiling a fortune. Their profits have risen along with their prices. Top executives are paid millions as their hospitals expand, buy expensive technology and build aggressively. And they benefit each year from a perk worth millions: They pay no income, property or sales taxes. These institutions were created with charitable missions. But many don’t act like nonprofits anymore. In their quest for growth and financial strength, they have contributed to the rising cost of health care, leaving thousands of patients with bills they struggle to pay…”
  • Most N.C. hospitals are slim on charity care, By Ames Alexander, Joseph Neff and Karen Garloch, April 22, 2012, Charlotte Observer: “Rachael Shehan has no health insurance and virtually no income. But when serious respiratory problems strike, her hospital has never provided financial help, she said. Instead, the 39-year-old Lenoir resident says, Caldwell Memorial Hospital has sent bill collectors who have hounded her for payment and ruined her credit. Now, she sometimes bursts into tears when medical problems arise. ‘I know the hospital isn’t going to help me with my bills,’says Shehan, who relies on food stamps and the help of friends. Nonprofit hospitals such as Caldwell Memorial are exempt from property, sales and income taxes. In return, they are expected to give back to their communities, largely by providing care to those who can’t afford it. Like Caldwell, most North Carolina hospitals are devoting a fraction of their expenses to help the poor and uninsured, an investigation by the Charlotte Observer and The News & Observer of Raleigh found. In 2010, most of the state’s hospitals spent less than 3 percent of their budgets on charity care – the practice of forgiving all or part of a patient’s bill…”

Medical Home Network – Chicago, IL

Coordinated care program aims to save Medicaid millions, By By Peter Frost, April 20, 2012, Chicago Tribune: “On Easter, Keontae Barnes doubled over in pain, her back and stomach tightening so much she thought she was in labor. Nearly eight months pregnant with her second child, a girl, Barnes headed straight to the emergency department at Holy Cross Hospital in the Chicago Lawn neighborhood, just a few blocks from her home. After a quick – and costly – examination, doctors determined it was a false alarm; her pains were normal for women in the later stages of pregnancy. The next day, her primary care doctor at Chicago Family Health Center called, asking Barnes what happened and making sure she was OK. ‘I was shocked. I said, ‘How did you know?” Barnes said. ‘She told me to come in the next day, and she gave me her emergency pager and her email. She said if I ever have any questions or concerns, I can always get in touch, any time of day.’  About a week later, Barnes did just that. Instead of rushing to the ER with intense chest pains, she called her doctor. Acid reflux. A trip to Walgreens solved the problem in short order and saved the state’s Medicaid program and Holy Cross thousands of dollars…”

State Medicaid Programs

  • Gregoire suspends plan to limit Medicaid emergency-room visits, By Carol M. Ostrom, March 31, 2012, Seattle Times: “A plan by the state Medicaid program to stop paying for emergency-room visits for all conditions deemed ‘nonemergency’ – set to go into effect Sunday – has been suspended by Gov. Chris Gregoire pending the outcome of budget negotiations under way in the state Legislature. Gregoire’s budget director, Marty Brown, said Saturday that Gregoire on Friday stopped the Medicaid plan from going into effect, noting growing legislative support for a less-drastic alternative. The alternative plan, pushed by Rep. Eileen Cody, D-West Seattle, is a modified version of a proposal offered by emergency-room doctors and hospitals, Brown said…”
  • Colorado Medicaid expansion to add 10,000, but many more out of luck, By Michael Booth, April 3, 2012, Denver Post: “Colorado’s latest Medicaid expansion is long overdue, health advocates say, but is burdened from the outset with a lottery system serving only 1 in 5 of those in need. The state starts taking applications this week for a new group of Medicaid patients – adults without dependent children – breaking a mold that long defined the insurance program in both scope and cost…”
  • Uncovering kids: 89,000 poor Pa. kids slashed from Medicaid, By Michael Hinkelman and Catherine Lucey, April 3, 2012, Philadelphia Daily News: “Kheli Muhammad was trying to schedule a routine pediatrician’s appointment last summer when she discovered that her 2-year-old son, who has a congenital heart disorder, had been kicked off the Medicaid rolls. The 30-year-old mother of two boys was stunned. ‘It is written in stone that he’s covered,’ Muhammad said of Samad, who qualifies for Medicaid based on his serious medical condition, not the family’s income level. ‘He’s pacemaker-dependent . . . [H]is heart will not beat without a pacemaker.’ But the heartbeat of the fragile little Samad was clearly not a priority for welfare officials, who informed Muhammad that she had failed to renew his benefits – even though she said she had not received renewal paperwork in the mail – and that she’d have to reapply…”