CHA, Other Groups To Push for Medicaid Payment Reform

TOPIC ALERT:

In response to President Obama's re-election and continued implementation of the Affordable Care Act, the California Hospital Association plans to form a coalition with hospital groups from other states to lobby Congress and HHS to reform Medicaid reimbursements, Payers & Providers reports (Payers & Providers, 11/8).

Background

Observers say that Obama's re-election means that implementation of the ACA will move forward in all 50 states (California Healthline, 11/7).

Dylan Roby -- director of economics at the UCLA Center for Health Policy Research -- said that Obama's re-election will help ensure that about 94% of Californians have health insurance in the next few years.

CHA Concerns

However, C. Duane Dauner -- CHA president -- said, "Will expanding coverage be good for every community and hospital? The answer is no."

Dauner said that state hospitals already are experiencing lower reimbursement rates for treating beneficiaries of Medi-Cal, California's Medicaid program. Medi-Cal payment rates are the 49th lowest among states and cover about 65% of treatment costs, according to Payers & Providers.

In addition, Dauner said that low- and moderate-income individuals who buy insurance through the state health insurance exchange -- created under the ACA -- could be a financial risk for hospitals. He said that such individuals might purchase lower-cost bronze- or silver-level health plans that have higher out-of-pocket costs for hospital care.

He said that the bronze plan would cover 60% of care costs, while the silver plan would cover 70% of care costs, leaving the patient to pay the rest. This could result in "bad debt for the hospitals," according to Dauner.

He said that the coalition being formed by CHA and other hospital groups likely will push for national Medicaid payment reform. Dauner added that more details on the coalition will be released next month (Payers & Providers, 11/8).

to share your thoughts on this article.