NWI hospitals, clinics worry about proposed Medicaid cuts - May 29, 2017

Courtesy of The Times of Northwest Indiana • May 29, 2017

By Giles Bruce

Northwest Indiana hospitals and safety-net clinics have their eyes on Washington, D.C., as federal lawmakers debate potentially severe cuts to Medicaid.

The U.S. House plan to repeal and replace Obamacare, the American Health Care Act, would reduce Medicaid spending by $834 billion (25 percent) over the next decade, according to an analysis by the nonpartisan Congressional Budget Office.

In that same time period, President Donald Trump’s proposed budget would decrease funding for Medicaid by $600 billion.

While neither the American Health Care Act nor Trump’s budget is likely to be enacted as is, the threat to the health program that serves nearly 57 million low-income Americans has Region hospitals and clinics worried.

“While it is too early to tell how the proposed federal budget would impact our hospitals, undoubtedly the proposed cuts to health care access would hurt the state’s most vulnerable patients,” stated Stacey Kellogg, a spokeswoman for Porter Regional, LaPorte and Starke hospitals.

She said the hospitals “will continue to provide medical care to the communities we serve, and remain committed to assisting anyone who needs help determining their eligibility for programs that offer health care coverage or medical assistance.”

The Trump administration and Congressional Republicans have proposed turning Medicaid into a block-grant program, where states get a set amount of money per Medicaid enrollee to spend how they see fit. The lawmakers say this will give states more flexibility, ultimately reducing costs.

Medicaid expansion helped hospitals

The American Health Care Act would do away with the enhanced federal funding for states that expanded Medicaid under the Affordable Care Act, likely spelling the end of Indiana’s expansion, the Healthy Indiana Plan 2.0. HIP 2.0 brought coverage to nearly 250,000 Hoosiers who previously had no health insurance or were underinsured, according to a state analysis. The program covers more than 400,000 people in total.

HIP 2.0 also has been a financial boon to hospitals, which agreed to fund part of the expansion through the state’s hospital assessment fee.

“It’s the right thing to do for patient care, to get people coverage so they can come in through the primary care physician’s doors and not the emergency room,” said Brian Tabor, president of the Indiana Hospital Association.

He said rural or safety-net hospitals in Indiana would be particularly affected by cuts to Medicaid, as a disproportionate share of those facilities’ patients are covered by the program. In Northwest Indiana, Methodist Hospitals in Gary and Merrillville, Franciscan Health hospital in Hammond, and St. Catherine Hospital in East Chicago are considered safety-net hospitals.

“In states like Georgia and others that didn’t have a coverage expansion, we have seen a number of hospital closures,” Tabor said. “If (expansion) went away here, I would be concerned we’d see situations like that.”

First, though, facilities might cut services, he said. For instance, rural hospitals could shut down their labor-and-delivery units since half of births in the state are covered by Medicaid.

He also noted that HIP 2.0 has expanded access to substance abuse treatment in Indiana, gains that also stand to be lost if the program goes away.

Clinics, nursing homes could be affected

HealthLinc CEO Beth Wrobel estimates her clinics stand to lose about $6 million annually (out of a $28 million budget) if the cuts are enacted, and would probably have to stop taking new patients. HealthLinc, a federally qualified health center, has locations in East Chicago, Valparaiso, Michigan City, Knox, Mishawaka and South Bend.

“Even more than what HealthLinc is going to lose, because we’ll be around, is what this would mean to our patients, to the health of our community,” Wrobel said. “Healthy people are able to get jobs.”

She has had patients who gained vision coverage through HIP 2.0 get glasses and go on to earn their commercial driver’s licenses and become truck drivers.

She noted that biggest growth in Indiana Medicaid spending in recent years has been on nursing home stays for older Hoosiers, a growing part of the population.

“There’s so much more to Medicaid than just pregnant women and kids and HIP,” she said.