To: Hospital CEOs and Government Relations staff
The House and Senate recently adjourned for August recess. Both houses will reconvene on September 5. In anticipation of meetings with members of the congressional delegation, we have developed talking points and provided some background information on the aftermath of Senate not moving forward with the proposals on the Affordable Care Act (ACA).
WSHA encourages hospital leaders to meet with their members of Congress during the break. Please let WSHA staff know if we can provide any assistance.
- Importance of Preserving Coverage. We applaud Congress’ decision not to repeal and replace the ACA. Washington’s hospitals support people having access to health coverage and services. More than 725,000 Washingtonians have ongoing access to health care through Medicaid expansion or subsidized insurance through the Health Benefits Exchange. Having insurance coverage means people are able to see primary care providers and take advantage of preventative care — instead of seeking care in a hospital emergency department. Over the long-run, this will lead to a healthier and more productive work force and slow the growth of health care costs.
- Insurance Market Stability Needed. We recognize there are problems with the ACA that must be addressed. We encourage Congress to tackle the instability in the individual insurance market by approving permanent funding for the cost-sharing subsidies that help offset the cost of co-payments and deductibles for low-income people. We also support the use of reinsurance pools and other mechanisms to help offset the higher costs of less healthy populations.
- While we support these insurance market stabilization measures, we also want to make sure that additional Medicare payment reductions aren’t used to offset their cost. Hospitals have already paid millions of dollars in Medicare and Medicaid cuts to help fund the ACA’s coverage expansion.
- Preventing Cuts to Hospitals. We also urge Congress to reject additional Medicare and Medicaid payment cuts to offset other proposals before Congress, such as raising the debt ceiling or extending the Children’s Health Insurance Program (CHIP).
- We are especially concerned about proposals to reduce Medicare payments to hospital-based clinics: the so-called “site neutral” payment policies. Hospital clinics are increasingly the only venue for access to Medicare and Medicaid beneficiaries. Reducing payments for these services will restrict access to care for seniors. Hospitals receive higher payments for these services because they face higher regulatory costs in serving this population. They also see sicker and more low-income patients.
340B Drug Discounts. Recently, CMS proposed severe 340B payment cuts to hospitals, which, if included in the final rule, would restrict access to life-saving drugs. Will you help us oppose this change in regulation? We hope you will join us in that effort, as well as opposing any legislative efforts to restrict the program.
Potential next steps and September’s congressional calendar
The Senate’s rejection last week of three proposals to repeal and partially replace the ACA has ended the health care debate for now. But that’s not the end of the health care story.
When Congress returns in September, it faces a jam-packed agenda that includes action to raise the debt ceiling, fund the government after October 1, approve an FY 2018 budget resolution and continue funding for CHIP. With such a packed schedule and only 12 legislative days in September, health care could easily get pushed to the back burner.
To address immediate concerns about the stability of the individual insurance market, the Senate HELP Committee — on which Sen. Murray is the senior Democrat — will hold hearings in early September with hopes of having a bill by mid-September.
Most important on their list will be funding for cost-sharing reduction (CSR) payments that help low-income health insurance exchange enrollees offset the cost of co-payments and deductibles. The Trump administration has threatened to end these payments. If it did, insurance premiums for people who get their coverage through the exchange would likely increase dramatically, and some plans would probably decide to get out of the market altogether.
Lawmakers have also discussed creating a reinsurance pool or stabilization fund that would give insurers extra funding to cover their most expensive patients.
On the House side, the bipartisan 40-member Problem Solvers Caucus has proposed similar measures. However, to date, no hearings are planned in the Energy and Commerce Committee, which has jurisdiction over insurance issues.
Meanwhile, two Republican Senators — Lindsay Graham (South Carolina) and Bill Cassidy (Louisiana) — are trying to build momentum for a very complicated proposal that would pool the federal money spent on Medicaid expansion, premium subsidies and subsidies for low-income people, and distribute it as block grants to states to use for health care. How states would use the money remains unclear.
Finally, the White House continues to pressure Congress to act on repeal and replace. Those requests seem to have fallen on deaf ears in the Senate.
It’s anyone’s guess what will happen next. Thank you all for your advocacy to date!
September’s Rural Advocacy Days in D.C.
It’s not too late to join your rural colleagues for WSHA’s annual Rural Advocacy Days in D.C. — September 26-27. WSHA provides a briefing and leads rural members on visits with their members of Congress. If you are interested in joining us, please contact Lori Martinez at firstname.lastname@example.org.
Meeting debriefs and questions
We are always interested in knowing the outcomes of your meetings with your congressional members. Please contact Chelene Whiteaker (email@example.com), Chris Bandoli (firstname.lastname@example.org) or WSHA’s federal lobbyist John Flink (John@jwfconsultingdc.com) about your meeting(s) or for any questions.