Tag Archives: State Federal Funding

How the American Health Care Act’s Changes to Medicaid Will Affect Hospital Finances in Every State

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http://www.commonwealthfund.org/publications/blog/2017/jun/how-changes-to-medicaid-will-affect-hospital-finances-in-every-state?omnicid=EALERT1231316&mid=henrykotula@yahoo.com

The American Health Care Act (AHCA), as passed by the U.S. House of Representatives, will reduce federal spending on Medicaid by more than $834 billion over the next 10 years. And the recently released Senate bill appears to cut Medicaid even more deeply. In addition to repealing the Medicaid expansion, the bills place caps on the federal dollars that states receive to provide health insurance to millions of low-income Americans, including the elderly, disabled, and people with opioid addiction.

We modeled the impact of this loss of Medicaid funding on U.S. hospitals and found that, over the next 10 years, hospitals in all states, but especially hospitals in Medicaid expansion states, will see an increase in uncompensated care—a treatment or service not paid for by an insurer or patient. We also saw declines in hospitals’ operating margins, particularly among hospitals in expansion states. Rural hospitals in nonexpansion states also would face marked operating margin decreases.

In the interactive state-by-state maps below, we present the estimated impact of the Medicaid provisions in the House-passed AHCA on the finances of all U.S. hospitals. The hospitals in the District of Columbia and the 31 states that expanded Medicaid are projected to see a 78 percent increase in uncompensated care costs between 2017 and 2026. Eleven of these states will see uncompensated care costs at least double between 2017 and 2026. For example, Nevada hospitals will see a 98 percent increase, West Virginia a 122 percent increase, and Kentucky a 165 percent increase.

In addition to growing uncompensated care, our projections indicate that under the AHCA, hospitals in most states will experience a decline in Medicaid revenues, even though the law restores Medicaid disproportionate share hospital (DSH) payments. Hospitals in Medicaid expansion states may experience a 14 percent drop in Medicaid revenues between 2017 and 2026, compared to a 3 percent anticipated reduction among hospitals in the 19 states that did not expand. Some states may see more dramatic drops. Arkansas hospitals, for example, are estimated to see a 31 percent decline in Medicaid revenue over the next 10 years.

Indiana, Pence’s Home State, Seeks Federal OK To Keep Medicaid Expansion

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http://khn.org/news/indiana-pences-home-state-seeks-federal-ok-to-keep-medicaid-expansion/

Statehouse of Indiana in Indianapolis (iStock/Getty Images Plus)

As Congress weighs repeal of the Affordable Care Act, the home state of Vice President Mike Pence Tuesday sought to keep its conservative-style Medicaid expansion under the federal health law.

Indiana applied to the Trump administration to extend a regulatory waiver and funding until Jan. 31, 2021, for its innovative package of incentives and penalties that are intended to encourage low-income Hoosiers on Medicaid to adopt healthy behaviors. Beneficiaries pay premiums, get health savings accounts and can lose their benefits if they miss payments.

Though Pence now supports the health law’s repeal, the Healthy Indiana Plan that he established in 2015 as the state’s governor has brought Medicaid coverage to more than 350,000 people. The architect of the plan was health care consultant Seema Verma, who has been nominated to head the Centers for Medicare & Medicaid Services.

Without Trump administration approval, federal money for Indiana’s expansion will run out Jan. 31, 2018. Indiana officials said the Medicaid expansion would continue even if Washington follows through on a Republican proposal to distribute federal Medicaid funds through a block grant program that would give states more flexibility in setting benefits and eligibility levels.

State officials refused to say whether the expansion would continue if Congress repealed Obamacare and eliminated funds for Medicaid expansions. If that happened, it’s unlikely states would have the money to make up for the lost federal aid.

Indiana’s effort to continue its Medicaid expansion demonstrates how states that expanded Medicaid under the Affordable Care Act — even Republican-controlled ones — are counting on additional federal dollars to pay for those expansions. It also reflects deadline pressure: They can’t wait for Congress to finish its debate over the future of the health law because they need to set budgets and programs now for next year.

According to Indiana’s request, continuing the Medicaid expansion will cost Indiana $1.5 billion but bring $8.6 billion in federal funding from 2018 to 2020.

“Indiana has built a program that is delivering real results in a responsible, efficient, and effective way,” Gov. Eric Holcomb, a Republican, said in a statement. “I look forward to maintaining the flexibility to grow this remarkably successful tool and to preserve our ability to respond to the unique needs of Hoosiers.”

Several other states including Kentucky and Ohio are considering adopting features of Indiana’s Medicaid plan.

 

California Faces Major Reversal If Trump, Congress Scrap Health Law

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California Faces Major Reversal If Trump, Congress Scrap Health Law

Attendees speak with heath care volunteers during the WeConnect Health Enrollment Information & Wellness Event in Oakland, California, U.S., on Saturday, Sept. 21, 2013. The battle over Obamacare is taking on political importance as Democrats hope a successful roll-out among Hispanics will further bind those voters to the Democratic Party and undermine Republican efforts to build more support before the 2016 presidential election. Photographer: David Paul Morris/Bloomberg via Getty Images

California has a lot to lose if President-elect Donald Trump and the Republican-led Congress fulfill their campaign pledge to repeal Obamacare.

The Golden State fully embraced the Affordable Care Act by expanding Medicaid coverage for the poor and creating its own health insurance exchange for about 1.4 million enrollees. Supporters held California up as proof the health law could work as intended.

But now President Barack Obama’s signature law is in serious jeopardy and California officials are left wondering what Republicans in Washington may put in its place.

“There is no doubt that Obamacare is dead,” said Robert Laszewski, a health care consultant and expert on the California insurance market. “The only question is just exactly how Republicans will get rid of it.”

Health policy experts don’t expect Republicans to immediately kick millions of people off their insurance policies. Instead, they predict lawmakers may repeal parts of the law and allow for some transition period for consumers while a replacement plan is put together.

Still, the personal and financial impact for the state could be jarring. The number of uninsured Californians would more than double to 7.5 million people if the Affordable Care Act was repealed, according to a recent study by the Urban Institute.

Researchers also said California stands to lose an estimated $15 billion annually in federal funding for Medicaid expansion and insurance subsidies — more than any other state. That loss of federal money would make it difficult for California to pursue health reform on its own.