ACA Survives but Other Pressing Issues Remain

GOP Can’t Muster ACA-Killing Votes

The latest effort to repeal the Affordable Care Act (ACA) fizzled out on Tuesday when Republican leadership in the U.S. Senate cancelled a vote after it became apparent they did not have the numbers needed for passage.

GOP Senators Rand Paul (Ken.), John McCain (Ariz.), and Susan Collins (Maine), citing various reasons, all signaled they could not support the Graham-Cassidy repeal-and-replace bill; those three votes together with the 48 Democrats uniformly opposed to Graham-Cassidy meant the measure was legislatively dead.

Tuesday’s non-vote followed a steady drumbeat of opposition to Graham-Cassidy from just about every part of the healthcare sector. MHA joined regional and national hospital groups, physician organizations, health insurers, and disease fighting associations, among many others in arguing that the Republican bill would raise healthcare costs, result in more uninsured, and run counter to bipartisan efforts that had recently been started to fix problems with the ACA.

On Monday, Senator Ed Markey (D-Mass.) held a forum in Boston with healthcare interests opposing Graham-Cassidy. Among those voicing opposition to the Republican plan were Massachusetts General Hospital President Peter Slavin, M.D., Boston Children’s Hospital President & CEO Sandra Fenwick, and MHA’s V.P. of Government Advocacy Mike Sroczynski.

Uncertainty on Subsidies Roils Insurance Market

Before the last minute Graham-Cassidy effort, the U.S. Senate’s HELP Committee – Health Education, Labor and Pensions – had begun to hold hearings on ways to improve the ACA and develop a bipartisan plan focused on addressing issues affecting access and affordability of insurance offerings in the individual market. And the committee’s Republican Chairman Lamar Alexander (Tenn.) and Ranking Democrat Patty Murray (Wash.) were investigating ways to fund the cost-sharing subsidies that help lower-income people afford co-pays and deductibles on health plans they buy through insurance exchanges. In statements throughout the ACA repeal-replace debate, President Trump has indicated that  his administration may not continue to support the subsidies. (A federal judge has ruled them illegal since Congress had not appropriated the funding; the case was appealed by the Obama Administration and it has yet to be taken up.)  This uncertainty has led many insurers across the U.S. to propose plans with massive premium increases. The insurers said that if they did not have a firm decision from the Trump Administration over the subsidies they had no choice but to raise premiums.

As Repeal Was Debated, Other Critical Issues Loomed

One of the biggest criticisms of the Graham-Cassidy legislative effort – and the one that Senator McCain cited as the reason for his non-support – involved how the bill was brought forward. McCain said the bill skirted the normal legislative process of holding open hearings through various committees where witnesses both for and against could voice their viewpoints. The national Graham-Cassidy debate also sucked air out of other pressing healthcare issues before Congress.

For example, MHA is concerned about federal Medicaid disproportionate share hospital (DSH) funding provided to states to support those hospitals that cover a large percentage of Medicaid recipients. Under the ACA, this funding was to be reduced annually over time. But Congress delayed the DSH cuts beginning in 2014; the most recent delay is scheduled to expire on September 30. In July, CMS announced through rule-making that it would, indeed, implement the ACA DSH cuts, effective October 1.  To date, Massachusetts had avoided those cuts through a special Medicaid waiver that helped fund the Bay State’s 2006 healthcare reform law. If the CMS proposal is implemented – that is, if efforts to delay it fail, or if Congress does not impose a legislative delay – Massachusetts will experience a 31.45% funding reduction in FY2018 alone, costing the state more than $100 million. The hit to Massachusetts is the biggest in the country given a recently proposed CMS formula that heavily weights the cuts to those states that have lower levels of uninsured.

MHA, Governor Baker, and the state’s Congressional delegation have all urged CMS to reconsider implementing the Medicaid DSH cuts and its formula.  Senators Elizabeth Warren and Ed Markey, along with Congressman Kennedy and others are currently seeking a legislative solution.

The Massachusetts delegation is also pressing for continuation of the Children’s Health Insurance Program (CHIP).  In Massachusetts, the CHIP program provides significant federal funding that supports MassHealth health coverage to approximately 160,000 low-income children. The CHIP program is only authorized through September 30, 2017, and Massachusetts will use all of its available CHIP funding later in FY2018 if the program is not continued.

Puerto Rico Relief Efforts

Puerto Rico, a U.S. territory whose inhabitants are U.S. citizens, is suffering. The island’s health infrastructure before Hurricane Maria was described in a January 2017 Urban Institute report as “financially unstable.” The post-hurricane situation is even worse; with power outages and shortages of fuel to run generators, health centers may have no option but to close. The state says it is not aware that Puerto Rico has requested nurses or other medical professionals through the Emergency Management Assistance Compact – the mutual aid system covering all states and U.S. territories. While medical professional should not self-deploy to disaster areas, caregivers along with the general public can help:

Support the Red Cross effort in Puerto Rico here.
Support United for Puerto Rico here.
Other disaster relief organizations can be found through the website of the National Voluntary Organizations Active in Disaster.

Healthcare Sector Says: Remove and Revise CMS Star Ratings

The much maligned “star” rating system, whereby CMS reduces the complex healthcare quality and patient satisfaction data on the Hospital Compare website to a rating of one-to-five stars, will continue.  CMS announced this past week that it would not update its Hospital Compare star ratings in October and will continue to keep posted the existing ratings released last December.  Hospital groups, including MHA and AHA, along with 225 members of the U.S. House and 60 Senators, all have urged CMS to ditch the rating system until the methodology can be improved.

Hospital Compare includes 57 individual quality measures – such as success in preventing central line-associated bloodstream infections – and shows how a hospital measures up against the state and national averages for that measure. Over many objections, CMS has grouped and weighted the measures to create an overall “star” rating – the most common of which, CMS concedes, is three stars. “The measures included in the ratings were never intended to create a single, representative score of hospital quality,” the American Hospital Association wrote in a letter to CMS on September 25.

Learn from Successful CHART Programs – Oct. 16

The Massachusetts Health Policy Commission is sponsoring a free conference based on the healthcare delivery transformations achieved through the CHART program. The conference will present the operating methods and lessons learned from CHART-funded programs that showed measurable successes on reducing readmissions for high-risk populations, reducing acute care use for high utilizers, and reducing ED visits for patients with behavioral health conditions. For the past two years, 24 Massachusetts community hospitals have used $60 million in CHART funding to create innovative, data-informed programs to improve care for high-risk populations in their communities. Through this October 16 program, caregiving teams at non-CHART hospitals can learn how their CHART-funded peers achieved success. The conference runs from 8:30 a.m. to 3:30 p.m. on Monday, October 16 at the Boxboro Regency Hotel and Conference Center.  Attendance is limited to the first 400 registrants. Reserve your seat here. For more information contact Carly Brownsberger at (617) 757-1632 or hpc-chart@state.ma.us.

MHA's Nicholas to Receive Arthritis Foundation Lifetime Achievement Award

MHA President & CEO Lynn Nicholas, FACHE, will be presented with the Arthritis Foundation’s lifetime achievement award at the foundation’s “Commitment to Cure” reception on Thursday, Oct. 12, 6 to 8:30 p.m., at the John F. Kennedy Presidential Library & Museum in Boston.  The foundation said the award recognizes “Lynn’s decade of service to Massachusetts in addition to her many other accomplishments in healthcare leadership.” More than 1.2 million Massachusetts residents are afflicted with arthritis.

Anyone who would like to attend or sponsor this special event, or make a contribution, can click here for details, or call (617) 762-2124.

The Arthritis Foundation will also present two practicing physicians with the Dr. Marion Ropes Award for excellence in arthritis care.  The Ropes Award recipients are: George Tsokos, M.D., chief, Division of Rheumatology, Beth Israel Deaconess Medical Center; and John E. Ready, M.D., chief, Orthopedic Oncology Service, Dana Farber Cancer Institute/Brigham and Women’s Cancer Center.

HPC Cost Trend Hearings Begin Monday

The Massachusetts Health Policy Commission (HPC) hosts its fifth annual cost trend hearing on Monday and Tuesday, October 2 and 3 at Suffolk University Law School. The hearing will feature remarks by Governor Charlie Baker, Attorney General Maura Healey, Senate President Stan Rosenberg, House Speaker Robert DeLeo, and cardiologist and health policy researcher Dr. Karen Joynt Maddox. In addition, nearly 20 Massachusetts healthcare leaders will offer sworn testimony.  You can review pre-filed testimony here, and the agenda and program booklet here.  The Monday hearing runs from 9 a.m. to 4 p.m. and the Tuesday hearing from 9 a.m. to 1:30 p.m.

John LoDico, Editor