Health care providers in Spokane agreed on one word to describe the U.S. Senate’s health care bill unveiled this week: devastating.
Leaders for Providence Health Care, Community Health Association of Spokane, Frontier Behavioral Health and the Washington State Hospital Association said in separate interviews that the bill, especially its deep cuts to Medicaid, would worsen care for their patients, lead to fewer jobs in health care and hurt their bottom lines.
“It’s not fulfilling the promise to be a more generous bill,” said Elaine Couture, CEO of Providence Health Services. “The proposed Medicaid cuts are very, very deep and more devastating than what we’d seen with the House’s.”
Both bills proposed by Republicans in Congress would roll back the Affordable Care Act’s Medicaid expansion. In Washington, the expansion allowed about 600,000 people to enroll in Apple Health.
Right now, Medicaid is an entitlement program, meaning anyone who qualifies can enroll and get coverage. Both Republican bills would end that, instead giving states a fixed amount per person enrolled in Medicaid.
The Senate bill bases that amount on historical Medicaid spending, with an annual adjustment based on the consumer price index. That would lead to deeper cuts over time, since the cost of medical care typically rises faster than the cost of all consumer goods in the U.S.
“I don’t think it really gets at providing better health care for anybody,” said Aaron Wilson, CEO of CHAS. “There’s just going to be a significant number of patients who lose access to health care.”
If the Medicaid expansion is rolled back, “what we’re going to see is that individuals will delay their health care because they’re not going to have coverage,” Couture said. People with chronic illnesses will wait until they’re seriously ill before going to the emergency room, where they can’t be turned away.
That clogs the emergency room with health issues that could be better managed by primary care doctors.
“Emergency room doctors and nurses are extraordinary at saving lives … but it’s not where you should go for your asthma or your hypertension or your diabetes,” said Mary Kay Clunies-Ross, vice president for membership and communications for the Washington State Hospital Association.
That’s true for patients with mental illnesses as well, many of whom have been able to get services through Frontier Behavioral Health thanks to the Medicaid expansion. CEO Jeff Thomas said people who are able to have regular appointments with counselors and psychiatrists now will wait until they’re in crisis to seek care and are likely to end up in overburdened jails, state mental hospitals or private hospitals for problems that could have been avoided with early care.
“I’d be shocked if anyone is weighing in in favor of this who’s in the medical or mental health field in general,” he said.
Both CHAS and Frontier expanded operations significantly in response to demand from newly insured Medicaid patients. Wilson said about one-third of current CHAS patients were covered under the expansion, and the system has added 250 jobs to provide care for them. If the expansion is rolled back, those jobs would be in jeopardy.
Hospitals do lose money serving Medicaid patients because the government reimbursement rates are lower than the actual cost of providing care. But when fewer people had Medicaid, Providence lost even more money providing charity care to people who had no insurance and couldn’t pay their emergency bills, Couture said.
One of the biggest misconceptions she encounters is that Medicaid patients are all homeless or unemployed, Couture said. In states like Washington that expanded Medicaid, the program is open to anyone making less than 138 percent of the federal poverty level: $15,800 for a single person or $32,300 for a family of four.
“We have people who are working jobs who qualify for Medicaid simply because their yearly income is at such a level,” she said. A single parent of two working full time under Washington’s minimum wage would qualify.
While the Medicaid rollback was the biggest concern, Clunies-Ross said state hospitals were also concerned about the bill repealing requirements for individuals to buy health insurance, and for most employers to provide it for full-time employees.
“They want people to not be dependent on government for health insurance but if you don’t then make businesses responsible for providing it, where are folks supposed to go?” she said.
She likened it to car insurance, which is also required by state law.
“Part of what makes insurance work is everybody paying,” she said.
Health care is unlike other businesses, because hospitals can’t legally turn people who need life-saving care away. Nor would they want to, she said.
Before the Affordable Care Act, some hospitals received federal government payments to make up for low Medicaid reimbursement levels. The ACA aimed to reduce those payments, reasoning that hospitals would be providing less charity care out of pocket because more people would have insurance.
The Senate and House bills would return hospitals to the pre-ACA world of caring for uninsured patients who can’t pay their bills without any additional funding for hospitals, she said.
“It weakens hospitals, big and small. There’s less revenue and more need,” Clunies-Ross said.