2020 Federal Public Policy Agenda
The Washington State Hospital Association federal public policy agenda guides the association’s congressional and regulatory advocacy activities. This agenda identifies public policies to enable hospitals and health systems to meet the challenges they face in serving the health needs of their communities.
WSHA’s public policy advocacy is focused on five areas:
- Increase health coverage;
- Access to high-quality services in all areas of the state;
- Delivery system transformation that rewards quality and greater value for dollars spent on care;
- An adequate supply of health care professionals; and
- A commonsense approach to health care regulation that ensures accountability but allows for flexibility to support a transforming health care system.
Increase health care coverage
WSHA is committed to the goal of affordable, comprehensive health insurance for every resident of Washington State. WSHA has concerns about proposals to cap provider rates as these fail to take into account access to needed health services in communities.
One step toward achieving this goal is to protect funding for vital federal programs, including Medicare, Medicaid, the Children’s Health Insurance Program, the Veterans Administration and the Indian Health Service.
In addition, Washington State has made significant coverage gains toward achieving this goal through Medicaid expansion, its health insurance exchange and other policies enacted in the Affordable Care Act (ACA). As a result, Washington State’s uninsured rate declined significantly.
But more can and must be done for patients. WSHA supports building on the foundation created by the ACA as we seek to further decrease the uninsured rate. Specifically, Congress and the Department of Health and Human Services should:
- Restore funding for the cost-sharing subsidies that help offset health insurers’ added costs for covering persons with serious medical issues;
- Establish a reinsurance program to assist individuals with high medical costs;
- Protect the ACA’s essential health benefits, which require health plans to offer a minimum set of benefits;
- Protect the ACA’s insurance reforms, which prevent health plans from discriminating against individuals with pre-existing conditions, removes lifetime caps and allows persons up to age 26 to remain on their parent’s insurance;
- Protect consumers from health plans that do not provide full coverage and do not meet all of the ACA’s consumer protections;
- Restore funding and resources for federal outreach and enrollment assistance, especially in rural and underserved areas; and
- Preserve the Medicaid program and delay the Medicaid Disproportionate Share Hospital cuts.
Access to high-quality services
WSHA is committed to preserving access to high-quality health care services in communities – from the largest to the smallest – across our state.
The first step to ensuring patients have access to health services is through coverage, a second and equally important step is to ensure payments for services are adequate. WSHA supports:
- Supporting fair and adequate reimbursement;
- Preserving the 340B program and slowing the growth of the cost of prescription drugs;
- Encouraging and supporting efforts to increase the behavioral health work force; and
- Expanding broadband coverage and telehealth services and supporting health information technology.
Specifically, WSHA opposes:
- Site neutral payment policies, which ignore the reality that hospital-based outpatient departments and clinics comply with far more extensive – and costly – regulatory requirements than physician offices or ambulatory surgery centers. Hospital departments and clinics also serve sicker, older and more low-income patients. In many communities, these departments and clinics are the only source of care for Medicare and Medicaid patients.
- Other cuts in the Medicare program, such as reductions in Medicare bad debt payments and in graduate medical education.
- Medicaid payment policies aimed at reducing funding to providers, such as adopting block-grants and restricting the use of provider assessments.
Principles governing efforts to ensure access in rural areas include:
- Promoting new models for the delivery of care to sustain access to vital services;
- Designing a system that fits the circumstances of unique communities; and
- Removing regulatory burdens, such as the 96-hour length-of-stay rule.
Delivery system transformation
WSHA is committed to delivery system reforms that reward quality and greater value for the dollars spent on care. We stand for providing care in a coordinated, seamless manner; focusing on prevention and wellness and putting our patients and their families at the center of care.
WSHA members are also in the forefront of transforming health care from a volume- to a value-driven environment, developing integrated delivery systems, coordination of care systems, population health models, and other innovations.
But for this effort to continue, existing barriers must be addressed. New alternative payment models must be developed, barriers to integration must be removed and investments must be made in the health care infrastructure.
WSHA is committed to ensuring an adequate supply of health care professionals and other staff. A major investment in training new physicians, nurses and other health care professionals is critical. Investment in the behavioral health work force is also crucial.
In the long-term, this means growing the number of primary care residency training programs, expanding nurse training opportunities and investing in training programs for other key health care workers.
In the short-term, this means reauthorizing the National Health Service Corps, the Teaching Health Centers program, nurse work force development programs like the Title VIII Nursing Workforce Reauthorization Act of 2019, and the Conrad State 30 J-1 Visa Program.
WSHA is committed to working toward commonsense regulations that protect patient safety and enhance quality while not overburdening providers. Regulatory compliance is a growing cost in hospitals, forcing hospitals to hire additional staff that at times do not add value to patient care. We saw progress in 2019, with positive regulatory reforms including revisions to the 42 CFR Part 2 privacy standards, proposed elimination of “direct” supervision of outpatient therapeutic services, minimizing auditing of compliance with the 96-hour rule for CAHs and the promise of reforms to the Stark anti-kickback and anti-trust rules.
However, more can be done. In this regard, WSHA endorses efforts by the American Hospital Association to identify specific regulatory barriers that should be eliminated. We also have serious concerns about the Centers for Medicare & Medicaid Services’ pricing transparency plans that will confuse patients because they do not take into account their insurance status and benefits.
Approved by the WSHA Board of Directors on December 11, 2019