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.