To pay for that coverage and incentivize the expansion of Medicaid, the plan would permanently cut billions in special federal funding for Medicaid to the non-expansion states starting in 2023, helping hospitals with disproportionately high rates of uninsured or Medicaid patients.
These cuts have unsettled hospital industry officials, who fear that losing these special funds would mean less money to pay for services. “We’re always in favor of expanding coverage,” said Beth Feldpush, senior vice president of America’s Essential Hospitals, which represents hospitals that treat many poor and uninsured patients. “Our concern is that it is paired with cuts in the safety net, and … that is a double-edged sword.”
The American Hospital Association estimates these funding cuts will amount to as much as $ 7.8 billion over 10 years. Industry groups say hospitals will need the additional Medicaid funding to treat the more than 25 million people who would remain uninsured even after the expansion of coverage.
One benefit for hospitals and healthcare providers is that health insurers in the market generally pay higher reimbursement rates than Medicaid – but they often come with higher deductibles that are difficult for patients and providers to pay for.
The massive spending package depends on Sen. Joe Manchin (DW.Va.), whose support is critical. The Democrats cannot afford to lose a party member’s vote in the 50-50 Senate, where Vice President Kamala Harris would cut ties and the GOP strongly oppose any government expansion. But Manchin has not yet said whether he will vote for the package.
Consumer advocates are thrilled that Congress can no longer wait for Republican-controlled lawmakers and governors to expand Medicaid. Republican leaders have cited a number of reasons for resistance, including that their states cannot afford the 10% requirement and that non-disabled adults do not deserve Medicaid. States could not block the expansion of coverage because it is not covered by Medicaid, which is jointly funded by the federal and state governments.
“This is a big deal,” said Anne Swerlick, a Tallahassee public interest attorney who worked with Florida lawmakers to expand Medicaid. “It would make an extraordinary difference in the quality of life for tens of thousands of Floridaers trapped in the void. In many cases it will be a lifesaver. “
Senator Raphael Warnock (D-Ga.), A key lawmaker advocating the determination, said Congress must “fill the gap in Georgia and the 11 other states where hard-working families wake up every day without health insurance, theirs.” Neighbors in 38 “. other states enjoy. ”But on Wednesday he said he and Georgia’s other Democrats in Congress are opposed to cuts in Medicaid’s special funding for hospitals.
While most states expanded Medicaid in 2014, no legislature has passed it since Virginia in 2018.
Those who didn’t adopt it are in the south, with the exception of Wyoming, Kansas, South Dakota, and Wisconsin.
In Georgia, Governor Brian Kemp and other GOP leaders have applied for federal approval for a partial expansion of Medicaid that would require work or other activities for eligibility. But the Biden administration has so far opposed this approach.
RD Williams, CEO of Hendry Regional Medical Center in Clewiston, Fla., Said the Democrats’ plan would cover about 60% of the uninsured who use his hospital, which serves one of the poorest parts of the state. “It will definitely have an impact,” he said.
Expanding coverage would help many patients better manage their health by giving them access to general practitioners and specialists. Medicaid applicants make up 25% of Williams patients, while more than 30% have no insurance coverage. “Our largest group of payers are the uninsured,” he said.
However, Williams said he is still trying to figure out how much money he might have to give up on Medicaid funding under the law. These cuts would come if Florida didn’t expand Medicaid.
Elijah Manley, 22, of Fort Lauderdale, Florida, raised more than $ 2,000 in bills after going to a hospital emergency room for COVID-19 treatment last year. Without insurance, he has no way of paying and fears that this will damage his creditworthiness. He hasn’t been insured since he aged Medicaid when he turned 21.
Manley works part-time in a bar and is also one of several Democrats running for a special area code for a seat in the US state house in January. He hopes Congress will pass a plan that will give him access to free or inexpensive insurance so that he won’t have to think twice about seeing a doctor.
It’s been nearly a decade since the Supreme Court narrowly upheld the ACA in 2012 but made its Medicaid extension provision optional for states.
Joan Alker, director of the Georgetown University Center for Children and Families, said the Democrats’ plan should motivate states to expand Medicaid as they could do so without losing their special Medicaid funding.
“If it moves states, that would be great, but it won’t happen,” said Chip Kahn, president of the Federation of American Hospitals, which represents for-profit hospitals.
Mississippi hospitals welcome the Democrats’ plan despite concerns about funding cuts.
“Hospitals would prefer a direct Medicaid extension, but at this point a thirsty man isn’t going to be really picky about bottled water, bottled water, or tap water,” said Richard Roberson, vice president of the Mississippi Hospital Association. “A reporting opportunity is better than nothing.”
The Medicaid gap has added to the financial troubles of rural hospitals in Georgia, which has led to recent closings, said Senator Jon Ossoff (D-Ga.). About people stuck in the shortfall: “It’s unfair and people suffer and die unnecessarily.”
Phil Galewitz is a reporter for Kaiser Health News. Andy Miller, a former AJC reporter, is the editor of Georgia Health News.
