Feds try to help state hospitals

By Bobby Harrison/NEMS Daily Journal

JACKSON – President Barack Obama’s administration officials are proposing rules to reduce the size of the cuts in federal funding to hospitals in states that do not expand Medicaid, such as Mississippi.
In those officials’ rules proposals to carry out the mandates of the Patient Protection and Affordable Care Act, the cuts in federal funds to treat people with no insurance, known as Disproportionate Share Hospital or DSH payments, would be administered in a way to reduce the size of the cuts to hospitals in states like Mississippi rejecting the Medicaid expansion.
Gwen Combs, vice president for policy for the Mississippi Hospital Association, said the cuts still would come, but their impact would be delayed for two years. Plus, she said that state hospitals still face other major cuts in federal funding because of provisions of the Affordable Care Act and other changes to federal law. She said that Hospital Association officials are still trying to determine the size of those other cuts.
Rep. Bobby Moak, D-Bogue Chitto, the minority leader in the state House, said he has seen estimates putting those cuts at $200 million for the upcoming federal fiscal year, which begins in October.
Moak said Tuesday the state needs to look at expanding Medicaid to cover those earning up to 138 percent of the federal poverty to offset the cuts to the hospitals.
The Affordable Care Act gives states the option to expand Medicaid to cover those earning up to about $15,000 annually with the federal government paying for the bulk of the cost. The Affordable Care Act is reducing the DSH payments under the assumption hospitals will have to provide less uncompensated care because of the expansion of Medicaid.
But many states with Republican-dominated legislators and governors are rejecting the expansion. Because of that rejection, Obama health care officials are formulating the rules on how the cuts in DSH payments will be made to lessen the hardship on hospitals in states that have not opted into the Medicaid expansion.
Still, Moak said, “there will be cuts to hospitals” in other areas that the Medicaid expansion could offset. “We can’t let our local hospitals, which are big economic engines, suffer major cuts.”
Plus, Moak said, offsetting the cuts to hospitals is important, but so is providing health care to allow people to be treated by a physician instead of going to an emergency room where the costs will be much more.
“It is a moral and economic issue,” said Moak, who has met with federal officials about how the expansion could work in Mississippi.
Mick Bullock, a spokesman for Gov. Phil Bryant, who opposes the expansion, said of the decision to lessen the impact of the DSH cuts for two years, “While Mississippi’s projected cuts may be less than previously anticipated, this temporary proposal is further evidence that Obamacare and its effects remain unclear and that it would be reckless to sign onto a massive entitlement expansion under this ‘train wreck’ of a law.”
It is estimated that the expansion would provide coverage to 300,000 Mississippians, primarily the working poor. Under the current Medicaid program, about 640,000 people are covered, primarily the disabled, poor pregnant women, poor children and the elderly.
But because of the fight over expansion, the Legislature adjourned the 2013 session without reauthorizing or funding the current program for the upcoming fiscal year, which starts July 1.
Bryant is expected to call a special session to take up the issue in June, though, he has said in recent days he might try to run the program without legislative funding or authorization, though, many say that would be problematic.
bobby.harrison@journalinc.com