HEALTH NEWS: Democrats’ Plan for South would Win Big, but South Hospitals Fear Funding Losss

dWeb.News Article from Daniel Webster dWeb.News


[UPDATED at 1 p.m. ET]

At least 2.2million low-income adults in Texas and the Southeast would be eligible to receive government-funded insurance under the Democrats’ $1. 75 trillion social spending and climate change plan.

That’s the number of people who are eligible for Medicaid under the Affordable Care Act but have been left uninsured because they live in one of the dozen states that have not expanded coverage under the 2010 law. They are in the coverage gap — with incomes too high to qualify for Medicaid, but below the $12,880 annual federal income minimum for an individual to qualify for subsidized coverage in the insurance marketplaces created by the ACA.

An estimated 60% of those caught in that Medicaid coverage gap are Black or Hispanic, according to the Center on Budget and Policy Priorities. And nearly two-thirds of those in the gap live in one of three Republican-controlled states: Texas (771,000), Florida (415,000) and Georgia (269,000), according to a KFF analysis.

The plan that President Joe Biden announced after negotiations with key Democratic legislators in Congress would allow those in the gap to be eligible for ACA Marketplace subsidies for four years, starting in January. They would get additional cost-sharing protections starting in 2023 that would bring their out-of-pocket costs close to zero.

To encourage existing Medicaid expansion states to maintain their coverage levels, the bill would raise the 90% federal matching rate for the expansion population to 93% from 2023 through 2025.

To help pay for that coverage and incentivize holdout states to expand Medicaid, starting in 2023 the plan would permanently cut billions in special federal Medicaid funding to the non-expansion states that helps hospitals with disproportionately high rates of uninsured or Medicaid patients.

Hospital industry officials are worried that losing these special funds will mean less money for services. “We are always in favor of coverage growth,” stated Beth Feldpush senior vice-president of America’s Essential Hospitals. This group represents hospitals that care for many uninsured and poor patients. “Our concern is that it is paired alongside cuts to the safety network and… that is an double-edged sword .”

The American Hospital Association has estimated those funding cuts would total as much as $7.8 billion over 10 years. Industry groups say hospitals need the extra Medicaid funding to handle the more than 25 million people who would remain uninsured even after the coverage expansion.

But an analysis by Matthew Fiedler for the USC-Brookings Schaeffer Initiative for Health Policy released Thursday found the expanded coverage would lift profit margins of hospitals in the non-expansion states by $11.9 billion in 2023 alone. Two main factors are cited in the report: hospitals receiving payment for services they provide but not currently getting paid for; and hospitals seeing greater demand as more people gain coverage.

Marketplace plans typically pay higher reimbursement rates that Medicaid, but often have higher deductibles. This can make it difficult for patients and providers to collect.

The massive spending package rests on Senator Joe Manchin (D-W.Va.), who is crucial. Democrats can’t afford to lose one party member vote in the 50-50 Senate, where Vice President Kamala Harris would break any ties and the GOP stands firmly against any government expansion. Manchin has yet to say whether he will support the package.

Consumer advocates are ecstatic that Congress may no longer wait for intransigent Republican-controlled legislatures and governors to expand Medicaid. Republican leaders have cited a host of reasons for resisting, including that their states can’t afford the 10% match and that nondisabled adults don’t deserve Medicaid. Because it is not covered by Medicaid, the expansion could not be blocked by states. Medicaid is jointly funded in part by the federal government and the state governments.

” This is a big deal,” stated Anne Swerlick, an attorney for public interest in Tallahassee that has advocated for the expansion of Medicaid in Florida. It would make a huge difference in quality of life for the tens of thousands Floridians who are caught in this gap. It will often be a lifesaver

Sen. Raphael Warnock (D-Ga.), a key lawmaker advocating for the provision, said Congress needs “to close the coverage gap in Georgia and the 11 other states where hardworking families wake up every day without health care coverage their neighbors in 38 other states enjoy.” But, on Wednesday, he said he and Georgia’s other congressional Democrats oppose the cuts to special Medicaid funding for hospitals.

While most states expanded Medicaid in 2014, no state legislature has adopted it since Virginia’s in 2018. Since 2017, six states have enacted expansion as a result of ballot initiatives, most recently Missouri.

Those who have not adopted it are in South, except for Wyoming, Kansas and South Dakota. Wisconsin already covers adults on Medicaid up to the federal poverty level but has not expanded it to match the 138% of that federal level called for under the ACA.

In Georgia, Gov.

In Georgia, Gov. Brian Kemp and other GOP leaders sought federal approval to expand Medicaid partially. This would require workers or other activities in order to be eligible. This approach has been rejected by the Biden administration.

R.D. Williams, CEO of Hendry Regional Medical Center in Clewiston, Florida, said the Democrats’ plan would cover about 60% of the uninsured who use his hospital, which serves one of the poorest parts of the state. He said, “It will definitely make an impact.”

Expanding coverage would allow many patients to better manage their health and have access to specialists and primary care doctors. Medicaid enrollees make up 25% of Williams’ patients, while more than 30% have no coverage. He stated that the uninsured are our largest payer group.

But Williams stated that he was still trying figure out how much money he would have to give up under the bill’s Medicaid funding. These cuts will occur unless Florida expands Medicaid.

Elijah Manley, 22, of Fort Lauderdale, Florida, racked up more than $2,000 in bills after going to a hospital emergency room for covid-19 treatment last year. He is unable to pay his bills without insurance and it could affect his credit. He’s been uninsured since he aged out of Medicaid when he turned 21.

Manley is a part-time bartender and one of many Democrats who are running in January’s special primary for a seat in the state House. He hopes Congress will approve a plan that allows him to have access to low- or free-cost insurance, so he doesn’t have to worry about visiting the doctor. He said that he would appreciate it, as he has a history of diabetes.

It’s been nearly a decade since the Supreme Court in 2012 narrowly upheld the ACA but made its Medicaid expansion provision optional for states.

Joan Alker, director of the Georgetown University Center for Children and Families, said the Democrats’ plan should motivate states to expand Medicaid because they could do so without losing their special Medicaid funding.

“If it moves states, that would be great, but it ain’t going to happen,” said Chip Kahn, president of the Federation of American Hospitals, which represents for-profit hospitals.

Mississippi hospital welcomes the Democrats’ plan, despite concerns over funding cuts.

“Hospitals would prefer a straight-up Medicaid expansion, but at this point a thirsty man is not going to be really choosy about whether it’s bottled water, mineral water or tap water,” said Richard Roberson, a vice president at the Mississippi Hospital Association. “Some coverage is better than none .”

The Medicaid gap has led to financial difficulties for rural hospitals in Georgia, leading recently to closures, stated Senator Jon Ossoff (D-Ga.). On people stuck in the coverage gap: “It’s unfair, and folks are suffering and dying needlessly.”

Anne Dunkelberg, health policy expert for the advocacy group Every Texan, said 80% of Texans in the coverage gap are in working households. “I am not going to celebrate until the ink dries but I would be thrilled for the working poor of Texas to have coverage .”

[Update: This article was updated at 1 p.m. ET on Nov. 4, 2021, to cite a new analysis from the USC-Brookings Schaeffer Initiative for Health Policy.]

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