Health care reform and the safety net rakove


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Health & Medicine Policy Research Group hosted a forum, “Health Reform and the Health Care Safety Net: Challenges and Opportunities,” on July 9 to explore the potential impact of health reform on the health care safety net nationally and in Illinois specifically.

The forum explored challenges and opportunities presented by health reform in Illinois, and examined the impact on community health centers, safety net hospitals, the health workforce, and vulnerable populations. Speakers included

*Michael McRaith, Director, Illinois Department of Insurance
*Julie Hamos, Director, Illinois Department of Healthcare and Family Services
*Claudine Swartz, Assistant Vice President for Policy, National Association of Public Hospitals and Health Systems (NAPH)
*Bill Foley, CEO, Cook County Health & Hospitals System
*Philippe Largent, VP for Government Affairs, IL Primary Healthcare Association
*Linda Murray, Chief Medical Officer, Cook County Department of Public Health, President-Elect, APHA
*Roberta Rakove, Senior Vice President, Government Affairs, Sinai Health System

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Health care reform and the safety net rakove

  1. 1. Health Care Reform and the Safety Net Priority Issues
  2. 2. Major Issues Impacting the Safety Net • Coverage Expansion • Payment Cuts • Unfinished Business • Innovations/Demonstrations
  3. 3. Coverage Expansion – The Good News • Effective January 1, 2014, Medicaid will be expanded to all individuals under age 65, including children, pregnant women, parents, and adults without dependent children, with incomes up to 133% of federal povery level • All newly eligible adults will be guaranteed a benchmark package of benefits • The federal government will finance 100% of the expansion from 2014 through 2016, 95% through 2017, 94% through 2018, 92% through 2019, and 90% thereafter
  4. 4. Coverage Expansion – The Good News • Premiums and cost sharing credits for individuals between 133% and 400% of federal poverty level will make coverage available for many working poor individuals • The law contains a state maintenance of effort requirement for Medicaid eligibility
  5. 5. Coverage Expansion – The Bad News • With the exception of a two year bump in Medicaid primary care physician rates to Medicare rates (2013- 2014) the law does not address Medicaid physician payment issues for primary or specialty care • Undocumented immigrants are not part of coverage expansions. Approximately one third of the uninsured in the metropolitan area are undocumented Hispanics, and there are significant numbers of other undocumented uninsured. • State maintenance of effort does not extend to payment rates
  6. 6. Coverage Expansion – The Questions • What are the implications for the current Illinois Medicaid payment system? • Will the State cut rates when the FMAP for new enrollees declines from 100%? • Will competition for primary care physicians in all communities impact the availability of physicians in poor communities? • What will demand for underfunded specialty services be? • Is there sufficient capacity, both inpatient and outpatient, in safety net systems? • What will be barriers to enrollment? • How do we change patterns of previously uninsured patients in accessing care?
  7. 7. Payment Cuts – The Good News • Is there any good news? • DSH cuts could have been worse • States and hospitals with higher percentages of uninsured than the national average will have a rebate on their DSH payments
  8. 8. Payment Cuts – The Bad News • Any DSH cuts are significant • Safety net hospitals are vulnerable to Medicare cuts • Safety net hospitals without large percentages of uninsured are more vulnerable on DSH cuts • Safety net hospitals are vulnerable on cuts related to readmissions unless funding is available to deal with the unique challenges of preventing readmissions in high risk communities • Many safety net hospitals will require additional resources to meet quality/value based purchasing requirements for Medicare reimbursement
  9. 9. Payment Cuts – The Questions • How will rebates on DSH payment cuts for high percentages of uninsured be calculated? • Will payment policies on readmissions and quality reflect the unique challenges of safety net hospitals and their patients?
  10. 10. Unfinished Business • 340b inpatient extension – may be dealt with in a limited way in the tax extenders bill • Safety net hospital infrastructure needs – capital and technology – are not addressed in the legislation • Adequate payment for Medicaid services remains in question • Coverage for undocumented individuals is excluded from the legislation and may require comprehensive immigration reform
  11. 11. Innovations and Grants • Opportunities to partner with the State of Illinois to control costs and improve care through demonstration projects, including: – Strategies to reduce readmissions in low income, high Medicaid communities, including innovative community based programs – Strategies to focus on the prevention and treatment of chronic diseases common in high Medicaid communities, including asthma and diabetes – Funding for community care networks serving low- income communities, such as the Comer proposal – is authorized in the legislation, and NAPH is seeking appropriations for these networks