While the world beholds the Federal government’s failure to respond effectively to a natural disaster in Puerto Rico, Americans are largely unaware that their local hospitals, that have always cared for the poorest among them, are now facing an entirely manmade fiscal disaster, thanks to the partisan dysfunction in Washington. What’s going on is not dissimilar to when two drunk parents get into a fight and they lose track of their baby and the stroller rolls into traffic because they are so focused on venting.
This inattention to details in Washington will have serious consequences for New Jersey’s charity care hospitals; Bergen Regional Medical Center, University Hospital in Newark, St. Joseph’s Hospital in Paterson, Jersey City Medical Center in Jersey City, Capital Health Regional Medical Center in Trenton and several others that NJ Spotlight flagged as having the heaviest charity care burden. As of Oct. 1, yesterday, New Jersey will lose over $160 million in so called DSH funds, which stands for Disproportionate Share Hospital funding. And those cuts in Federal aid are expected to grow every year exponentially.
Now, if you only get your news from MSNBC you probably won’t have heard much about this because these cuts are not the consequence of anything that President Trump or the Republican controlled Congress did. Ironically, these cuts, which will cost the nation’s 3,000 hospitals that qualify for DSH funding tens of billions between 2018 and 2025, were set into black letter law in President Obama’s Affordable Health Care Act. It was a ticking time bomb for safety net hospitals and everybody who follows hospital finance closely knew it.
The ‘theory’ behind these reductions in support was that as more and more people were insured under ACA, Washington could reduce the support it had historically extended to these institutions. No doubt, ACA was a great success in bringing down the ranks of the uninsured from 44 million in 2013 own to 28 million Americans without health care in 2016. According to the Kaiser Family Foundation 78 percent of those uninsured were American citizens and at least three quarters of the uninsured had at least one full-time worker in the family. For close to half of these households, according to KFF polling data, even the subsidized coverage offered by the ACA was too expensive.
Thanks to ACA by 2015 New Jersey was able to push down the percentage of its uninsured to 10.9 percent of the state’s population. Yet, still close to a million residents still lacked any coverage, including a half-million undocumented immigrants who were expressly excluded from the ACA.
For a few years running Congress voted to put off the ACA mandated DSH cuts. After all, the concept of supplemental Federal funding to help community safety net hospital was an example of bipartisan decency going back to when President Reagan signed it into law. Like the old bi-partisan coalition that helped enact and sustain Food Stamps, members of Congress from rural states and states with big cities, irrespective of party, came together because they put their constituents in need ahead of scoring partisan points.
Last month, there was a faint echo of that bygone era when more than two hundred members of Congress from both parties signed on to a letter to their leadership urging “swift action to delay these harmful cuts for at least two years.”
Their letter continued. “President Ronald Reagan and Congress created Medicaid DSH payments to sustain hospitals that serve a disproportionate number of low-income and uninsured patients. In treating those who have nowhere else to turn, these hospitals incur substantial uncompensated costs. Furthermore, these same hospitals typically operate on very narrow, or even negative, margins. Medicaid DSH payments allow them to continue serving our constituents. Medicaid DSH payments not only support hospitals in cities across the country, these payments are also especially important to rural hospitals, which often face added financial burdens.”
“Our nation’s hospitals cannot sustain losses of this magnitude. Institutions will be forced to shutter, leaving our constituents without a safety net,” the members predicted. The lead signatories were Rep. Eliot L. Engel, (D-NY) Rep. John A. Culberson, R-Tx) and Rep. Steven M. Palazzo (R-MI).
BUT IT GETS WORSE
But the billions of ACA cuts to safety net hospitals is only part of the great unraveling of a bi-partisan safety net that had been in place for years. As NJ Spotlight reported last week, Oct. 1 also marked the deadline to both renew two other critical safety net programs; the Children’s Health Insurance Program (CHIP) and support for the thousands of Federally Qualified Health Centers across the country.
CHIP, which provides low cost health care coverage to nine million children, was passed back in 1997 under President Clinton and continued through the eight years of President George W. Bush. It has been credited with reducing the percentage of uninsured from close to 14 percent, before the law was enacted, to 4.5 percent in 2015. Close to nine million children are signed up. Between Medicaid and CHIP, the two programs insure 43 percent of all of the nation’s children.
With close to 231,000 kids signed up in CHIP alone, New Jersey ranks eighth highest in the number of children covered out of all 50 states and the District of Columbia. With Governor Christie’s decision to take the opportunity offered by the ACA to expand Medicaid coverage, close to 800,000 New Jersey kids got coverage thanks to NJ FamilyCare. According to the Advocates For New Jersey Children’s annual survey New Jersey Kids Count, thanks to both CHIP and Medicaid just 3.7 percent of the kids in the state were uninsured. “Children need quality healthcare to grow into healthy adults,” the ACNJ report said. “Research shows that children who have health insurance coverage are more likely to receive the preventive care they need to avoid medical problems that require costly and painful treatment.”
Why would you want to put that hard won progress in peril?
BUT THERE IS MORE
Incredibly, on the someday Oct. 1, Congress and the Trump administration let the deadline pass for re-authorizing the Federal Quality Health Care Centers, another critical part of that bi-partisan safety net both parties in Washington have historically supported. The initial concept of federally supported health care centers for the underserved and most at risk populations goes back to President Lyndon Johnson’s War on Poverty. In 1989 Congress followed up, designating “”Federally Qualified Health Centers” that were to be funded by the Public Health Service Act and would provide basic health services regardless of a patients ability to pay.
Today, these life saving and disease preventing community health centers operate in more than 9,500 locations, serving 27 million people. They provide a vital pressure release valve for already over taxed hospital emergency rooms. “They are the main source of health care for many low-income Americans — and the only source of primary care in many underserved areas,” according to Kaiser Health News. “Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay.”
“The anxiety level is increasing on almost a daily basis,” Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) told Kaiser Health News.“There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”
In an op-ed in the Jersey Journal former Assemblywoman Joan Quigley warned that Congress’s failure to act to fund the centers would undermine a program that saves “the US healthcare system about $24 billion a year by limiting emergency room visits and improving health outcomes.” Ms. Quigley wrote that the stakes were high here in New Jersey. “North Hudson Community Action Corporation’s eleven health centers treated 71,666 individuals last year in Hudson, Bergen and Passaic Counties. Jersey City-based Metropolitan Health Center treated 16,566 persons, and Alliance Community Healthcare, also based in Jersey City, treated several thousand more.”
“Congress is sick and tired of talking about health care, so few in Washington are paying attention to a financial crisis they’re inflicting on a program both parties have always been very proud of,” she wrote. “But if they don’t fix the problem they created two years ago, plenty of people will be hurt and angry.”
A THREAT TO THE POOREST POSES A RISK TO ALL
In a recent on line op-ed Dr. Glenn Fennelly, Chair and Professor of Pediatrics, at Rutgers New Jersey Medical School, warned attention needed to be paid to a recent hepatitis outbreak in San Diego because it illustrated the need for an actual expansion of the Federally Qualified Health Centers. The outbreak was among that city’s homeless population. It sickened 421 and killed 16 others. “Because they did not have access to basic vaccines, sanitation and hygiene, these victims were invisible to the health care system,” Dr. Fennelly wrote. “An effective response to prevent a repetition of this tragedy throughout the US would be to expand federally qualified health center (FQHCs) that have the capacity to address the health care needs for all segments of society including the most vulnerable, regardless of citizenship status or ability to pay.”
So, just what were we focused on in the days leading to the triple threat to our health safety net that passed this Sunday without action? Why it was the departure of the disgraced outgoing Health and Human Services Secretary Tom Price for wasting close to a million taxpayers dollars on luxury private jet and military aircraft charters.
Now, we are caught with both the very worst of the ACA in tact, and a White House that is hell bent on derailing what works.