Updated: Thursday, September 28, 2017, 10:00 AM
I feel like patients and their providers have been repeatedly put through the wringer, with a political promise on one side, sweeping and disruptive policy changes on the other, and people’s lives in the middle.
With each successive push to repeal and replace the Affordable Care Act, hospitals, doctors, nurses, nursing homes, and others have been working together to carefully assess the potential impact on consumers and patients. After the stalling of Congress’ third big attempt — in just nine months — to repeal and replace, 27 Pennsylvania health care groups are breathing a temporary sigh of relief.
But, more importantly, as we once again pick ourselves up from the latest fire drill, these groups agree on some specific, short-term, practical, somewhat bipartisan actions that Congress can take right now — some this very week — to put Pennsylvania’s health care on more solid footing.
1. Keep Pennsylvania kids covered: Invest in CHIP by September 30
Protecting the health of our children — all of our children — is one of the best investments we can make in our collective future.
Right now, in Pennsylvania, we are succeeding with that investment. Because of CHIP (the Children’s Health Insurance Program) and Medicaid, 95 percent of our children have health insurance. That includes children in families and households that have low incomes, or where the breadwinner(s) don’t get health insurance through their jobs. Let’s keep it that way. Congress should reauthorize funding for CHIP immediately, before it expires on September 30.
2. Shore up the marketplace in the short term: Pay insurers for cost-sharing subsidies — or expect rate increases to double
Rushing to vote on sweeping proposals to repeal and replace Obamacare because it is driving up premiums and deductibles, is both a bit of an exaggeration (at least here in Pennsylvania), as well as a case of the tail wagging the dog.
What’s also clear is that these mischaracterizations, coupled with big, hastily conceived changes, run the risk of becoming self-fulfilling prophecies.
According to this week’s testimony from Pennsylvania’s Acting Secretary of the Department of Human Services (and former Insurance Commissioner), Teresa Miller:
The vast majority of Pennsylvanians get their health coverage through their jobs, Medicare, or “traditional” Medicaid. For these kinds of health insurance, the Affordable Care Act has strengthened consumer protections and access to comprehensive health coverage without bending cost curves sharply up. In fact, cost increases for employer-based insurance appear to be slowing. About 5 percent of Pennsylvanians get their insurance through the individual market — mostly through the federal Health Insurance Marketplace (healthcare.gov) — because their jobs don’t provide coverage. In Pennsylvania, this individual market appears more stable than elsewhere. Insurers here requested an average rate increase of 8.8 percent for 2018.
However, Pennsylvania’s insurance rates have yet to be finalized. They assume a continuation of the “current federal regulatory structure” — in other words, the continuation of the Affordable Care Act.
Insurers are saying that, in order to stabilize the individual market in the short term, we should protect the Affordable Care Act’s individual mandate and honor its cost-sharing reduction provisions.
Without cost sharing, insurance rates could go up an average of more than 20 percent. Without either cost sharing or the mandate, rates could go up an average of more than 35 percent.
3. Protect vulnerable communities: Extend payments that help community clinics, rural hospitals, and hospitals that serve vulnerable communities
Authorization for several provider payments and other funding that supports Pennsylvania’s most vulnerable communities is about to expire. Congress should immediately reauthorize funding for:
The Community Health Center Fund. This fund supports 300 community health center locations, where one in 16 Pennsylvanians receive care, in 52 counties across the state. Without Congressional action, these centers could see a funding cut of up to 70 percent. Payments that help rural hospitals keep their doors open. Pennsylvania’s 42 rural hospitals are the primary, and sometimes only, source of care in their communities. Last year, more than half (56 percent) of those hospitals had negative total margins. Payments that support the hospital safety net. Impending cuts will jeopardize the stability of that support system.
Andy Carter is president and CEO of the Hospital and Healthsystem Association of Pennsylvania, representing more than 240 acute and specialty care hospitals and health systems across the state providing care for 12.7 million Pennsylvanians.