CHA, Other Groups To Push for Medicaid Payment Reform

In response to President Obama's re-election and continued implementation of the Affordable Care Act, the California Hospital Association plans to form a coalition with hospital groups from other states to lobby Congress and HHS to reform Medicaid reimbursements, Payers & Providers reports (Payers & Providers, 11/8).

Background

Observers say that Obama's re-election means that implementation of the ACA will move forward in all 50 states (California Healthline, 11/7).

Dylan Roby -- director of economics at the UCLA Center for Health Policy Research -- said that Obama's re-election will help ensure that about 94% of Californians have health insurance in the next few years.

CHA Concerns

However, C. Duane Dauner -- CHA president -- said, "Will expanding coverage be good for every community and hospital? The answer is no."

Dauner said that state hospitals already are experiencing lower reimbursement rates for treating beneficiaries of Medi-Cal, California's Medicaid program. Medi-Cal payment rates are the 49th lowest among states and cover about 65% of treatment costs, according to Payers & Providers.

In addition, Dauner said that low- and moderate-income individuals who buy insurance through the state health insurance exchange -- created under the ACA -- could be a financial risk for hospitals. He said that such individuals might purchase lower-cost bronze- or silver-level health plans that have higher out-of-pocket costs for hospital care.

He said that the bronze plan would cover 60% of care costs, while the silver plan would cover 70% of care costs, leaving the patient to pay the rest. This could result in "bad debt for the hospitals," according to Dauner.