​Mandate repeal gets more complicated

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Senate Republicans are still moving ahead with their tax overhaul, but the bill’s health care components —namely, repealing the individual mandate — got thornier yesterday.

On the Senate side: GOP leaders told Sen. Susan Collins they would agree to pass two health care measures to offset the damage from repealing the mandate: the ACA stabilization bill from Sens. Lamar Alexander and Patty Murray, and Collins’ proposal to establish a new reinsurance program with about $5 billion in federal money.

  • Alexander-Murray would not have much effect at all, the Congressional Budget Office said yesterday. CBO still expects repealing the mandate to produce about 13 million newly uninsured Americans and premium hikes of about 10%, on average.
  • As it did in its initial score of the Alexander-Murray legislation, CBO assumed the ACA’s cost-sharing payments were still being made, even though they are not. This is weird, and it does produce more conservative estimates of the bill’s impacts. But it’s not new, and GOP leaders on the Senate Budget Committee have some input into CBO’s assumptions on this front.
  • As for reinsurance, Majority Leader Mitch McConnell has told Collins he’s on board.

The other side: The House is not on board. Rep. Mark Meadows, the influential chairman of the House Freedom Caucus, said yesterday that he opposes new reinsurance funding, according to The Hill. It’s not entirely clear whether Alexander-Murray could pass the House outside of a larger package, either.

Don’t forget about entitlements. Sen. Bob Corker’s colleagues are not wild about his idea for a “trigger” that would automatically raise taxes if these tax cuts don’t end up paying for themselves. Some are talking instead about a “trigger” that would cut spending — including spending on Medicare and Medicaid.

  • A similar trigger already exists: As it stands, the tax bill would already prompt some $25 billion in Medicare cuts, thanks to existing rules that call for automatic spending cuts to counteract new laws that add to the deficit — which the tax bill would. An ACA payment program for insurers would also be cut substantially under those automatic reductions.
  • The New York Times has a good visualization of these automatic spending cuts.

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Healthcare Triage News: Lots of Children Are About to Lose Their Health Coverage

Healthcare Triage News: Lots of Children Are About to Lose Their Health Coverage

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Budget authorization for the Children’s Health Insurance Program in the US ran out a couple of months ago, and there’s no reauthorization in sight. A LOT of kids are insured through this program.

Hospitals With History Get A Second Life

https://khn.org/news/hospitals-with-history-get-a-second-life/

When Laura Kiker rented a new apartment in September a few blocks from the U.S. Capitol in Washington, she knew she was moving into a historical neighborhood.

She had no idea, though, that her new home at 700 Constitution Ave. Northeast was a former hospital dating back nearly a century.

Today, she loves living in what used to be a patient room, in a four-story building with wide hallways, high ceilings and restored post-World War II-style architecture. A spacious rooftop deck, yoga studio and indoor dog wash are added bonuses for Kiker, and her dog, Stella. “There is so much history in this town, it’s nice to live in a place that has its own,” said Kiker, 30, a management consultant.

Across the country, hospitals that have shut their doors are coming back to life in various ways: as affordable senior housing, as historical hotels and as condos, including some costing tens of millions in the heart of New York’s Greenwich Village.

When Laura Kiker rented a new apartment in September, a few blocks from the Capitol, she had no idea that her new home, at 700 Constitution Ave. in Northeast Washington, was a former hospital dating back nearly a century. (Katherine Frey/The Washington Post)

The trend of converting hospitals to new uses has accelerated as real estate values have soared in many U.S. cities. At the same time, the demand for inpatient beds has declined, with the rise of outpatient surgery centers and a move toward shorter hospital stays.

As health systems consolidate for financial reasons, they might prefer that patients visit their flagship hospital while buildings related to smaller hospitals in their orbit get sold off — especially if the latter have a disproportionate share of indigent patients.

David Friend, chief transformation officer at the consulting firm BDO in Boston, noted that real estate is one of urban hospitals’ most valuable assets. “A hospital could be worth more dead than alive,” he said.

The number of hospitals in the U.S. has declined by 21 percent over the past four decades, from 7,156 in 1975 to 5,627 in 2014, according to the latest federal data.

Even when the conversions make medical sense, they pull at the heartstrings of communities whose residents have an emotional attachment to hospitals where family members were born, cured or died. But they sometimes create health deserts in their wake.

St. Vincent’s Hospital in New York treated survivors of the Titanic’s sinking in 1912, the first AIDS patients in the 1980s and victims of the 9/11 terrorist attacks in 2001, went bankrupt and closed seven years ago. Developer Rudin Management bought it for $260 million and transformed it into a high-end condo complex, which opened in 2014. Earlier this year, former Starbucks CEO Howard Schultz reportedly bought one of the condos for $40 million.

Jen van de Meer, an assistant professor at the Parsons School for Design in New York, who lives in the neighborhood, said residents’ protests about the conversion were not just about the optics of a hospital that had long served the poor being repurposed. “Now, if you are in cardiac arrest, the nearest hospital could be an hour drive in a taxi or 20 minutes in an ambulance across the city,” van de Meer said.

St. Vincent’s is one of at least 10 former hospitals in New York City that have been turned into residential housing over the past 20 years.

But many older hospitals are too outmoded to be renovated for today’s medical needs and patient expectations. For example, early 20th-century layouts cannot accommodate large operating room suites and private rooms, said Friend.Closing a hospital and converting it to another use is not exactly like renovating an old Howard Johnson’s, said Jeff Goldsmith, a health industry consultant in Charlottesville, Va. “A hospital in a lot of places defines a community — that’s why it’s so hard to close them,” said Goldsmith, who noted that after Martha Jefferson Hospital closed its downtown facility in 2009 to move closer to the interstate highway, an apartment building took its place.

Real estate investors say the location of many older hospitals — often in city centers near rail and bus lines — makes them attractive for redevelopment. The buildings, with their wide hallways and high ceilings, are often easy to remake as luxury apartments.

Spurring Development

In some circumstances, a conversion provides a much-needed lift for the community. New York Cancer Hospital, which opened on Central Park West in 1887 and closed in 1976, was an abandoned and partially burned-out hulk by the time it was restored as a condo complex in 2005. Developer MCL Companies paid $24 million for the property, branded 455 Central Park West.

“The building itself is fantastic and a landmark in every sense of the word,” said Alex Herrera, director of technical services at the New York Landmarks Conservancy. He noted that it retained some of its original 19th-century architecture.

But by the time the condominium opened early this year after a five-year, $40 million renovation, the response was positive.Nicky Cymrot, president of the Capitol Hill Community Foundation in Washington, D.C., a neighborhood group, said that when Specialty Hospital Capitol Hill sold off a little-used 100,000-square-foot wing of its facility that became 700 Constitution, neighbors weighed in with concerns about aesthetics and traffic. The building was first known as Eastern Dispensary Casualty Hospital, which opened in 1905.

Sophie White, 28, who moved into 700 Constitution this summer, watched the building’s transformation and renovation from a rental property a few blocks away. “It used to be a blight on the neighborhood with unsavory people milling around it,” she said. “Now, it’s a bright spot and with its dog park out front, it’s really a cool place to live.”

Nearly half of the 139-unit building, where one-bedroom apartments rent for nearly $2,600 per month, is already leased. Asked why former hospitals are being bought and redeveloped as housing: “It’s all about location, location, location,” said Terry Busby, CEO of Arlington-based Urban Structures.

Likewise Columbia Hospital for Women, which had delivered more than 250,000 babies since it opened shortly after the Civil War, closed in 2002 and reopened in 2006 as condos with a rooftop swimming pool in the city’s fashionable West End.

Some former hospitals are used for purposes other than housing.

In Santa Fe, N.M., St. Vincent Hospital moved into a new facility in 1977 and the old structure downtown was reborn as a state office building. Later, it was abandoned and locals listed it as one of the spookiest places in town. In 2014, the building reopened yet again as the 141-room Drury Plaza Hotel.

‘A Building With Tremendous History’

After Linda Vista Community Hospital, in L.A.’s Boyle Heights neighborhood, closed in the 1990s, the abandoned six-story building fell into disrepair — its empty patient rooms, discarded medical equipment and aging corridors serving as sets for movies such as “Pearl Harbor” and “Outbreak.” Amcal Multi-Housing Inc. bought the property in 2011 and redeveloped it into a low-income senior apartment house called Hollenbeck Terrace.

“They really rescued a building with tremendous history … while providing really needed low-income senior housing,” said Linda Dishman, CEO of the Los Angeles Conservancy, a group dedicated to preserving and revitalizing historical structures. “It is such an iconic building in the neighborhood.”

Fitch: Rating downgrades will likely outweigh upgrades for US healthcare companies in 2018

https://www.beckershospitalreview.com/finance/fitch-rating-downgrades-will-likely-outweigh-upgrades-for-us-healthcare-companies-in-2018.html

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US healthcare companies will likely see more credit rating downgrades than upgrades in 2018, according to Fitch Ratings.

Fitch attributes the increased pressure on industry credit ratings to the uncertain future of the ACA, a changing tax plan, the adoption of alternative payment models and the potential for outsider disruption, which includes Amazon’s entrance into healthcare and advancements in technology.

Further, Fitch explains that technology is increasingly moving patients away from hospitals and enabling decentralization — thus reshaping the healthcare landscape. Due to this changing landscape, the healthcare industry is, “facing secular challenges to pricing power and profitability and these forces are expected to influence certain segments more than others in 2018,” Fitch notes.

However, despite the higher potential for credit downgrades, the US healthcare sector outlook is stable for 2018 due to sheer demand for services, an overall favorable liquidity profile, and generally consistent leverage and debt coverage.

 

Freedom Caucus chair opposes ObamaCare funding pushed by GOP senator

Freedom Caucus chair opposes ObamaCare funding pushed by GOP senator

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House Freedom Caucus Chairman Mark Meadows (R-N.C.) said Wednesday that he opposes ObamaCare funding known as “reinsurance” that was part of a commitment given to Sen. Susan Collins(R-Maine) to help gain her vote for tax reform.

“That’s a totally different thing because that actually puts more money into a failing system where the money will not actually lower premiums and reduce costs in a substantial way,” Meadows told The Hill. “I think that’s a bigger problem.”

Meadows’s objections, and those among House Republicans more broadly, could be an obstacle to the deal that Collins worked out on Tuesday.

Collins said that President Trump had agreed to support the reinsurance funding, as well as another bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), to help assuage her concerns about repealing ObamaCare’s individual mandate in the tax bill.

Senators said those two ObamaCare bills could be added to a must-pass government funding bill after the tax bill passes the Senate. But Meadows’s objections are an obstacle in that situation.

Reinsurance is government funding that helps pay for the cost of sick enrollees, with the intention of bringing down premiums. But conservatives oppose it as simply throwing more money at the health-care law.

Meadows was more open to the Alexander-Murray bill, but said that he wanted certain concessions for Republicans on that before adding it to a short-term government funding bill, known as a continuing resolution (CR).

“The Alexander-Murray bill, the problem with it is that it was more give on Sen. Alexander’s part than Sen. Murray’s part, so suggesting that Sen. Murray would perhaps be a little bit more engaging in the negotiation, I would certainly be willing to [work with them],” Meadows said.

The Alexander-Murray bill funds key payments to insurers for two years in exchange for more flexibility for states. But conservatives say the flexibility in the bill currently is not substantial.

Meadows said Wednesday he is willing to work on the issue.

“I think with the CR really at this point, I’ve been one that’s been willing to work with our Senate colleagues on a CR,” he said.