MEDICAID: BOREN AMENDMENT REPEALED IN BUDGET DEAL
The federal law that sets minimum reimbursement rates forThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
what states pay hospitals and nursing homes, known as the Boren
Amendment, would be repealed under the balanced budget deal
expected to receive congressional approval today, NPR's Siegel
reports. The measure "has been a sore point among governors,"
who have fought for repeal of the law "ever since it was
enacted." Gov. Mike Leavitt (R-UT) said that the law "limits
states' abilities to get the best deals from providers." He
said, "What the states would like to do is say to a number of
providers, 'Tell us what it is that you can provide this service
for and compete on the basis of your quality and your price and
we'll choose on the basis of competition'" ("All Things
WINNERS & LOSERS: Gov. Pete Wilson (R-CA) said of the
proposed repeal, "We see this as a victory for California and all
the other states" (Green, COPLEY NEWS SERVICE/San Diego UNION
TRIBUNE, 5/20). However, "[h]ealth care providers argue that
repealing the law would allow states to reduce their payments.
And, they say, that would affect the availability and the quality
of care that patients receive," according to NPR. Medicaid
providers contend "payment rates are already low, and if the
Boren Amendment is repealed, nothing would prevent states from
reducing the rates even further." Jim Bentley, of the American
Hospital Association, said rate reductions "could affect the
quality of care given to patients, even their access to care,"
with "many urban and rural hospitals" being the most adversely
affected. Bentley said, "What we will have is increasing
hospital deficits. And, because hospitals with high Medicaid
populations also often have high uncompensated care patient
loads, the most vulnerable hospitals financially ... will be the
ones most at risk."
NOT SO FAST: NPR's Que reports that Clinton administration
officials "argue states are unlikely to let this happen." Health
Care Financing Administration Administrator Bruce Vladeck said
"states have a strong interest in seeing that hospitals and
nursing homes stay open." He said, "They serve all the citizens
in their community, not just those that are on Medicaid. They
are also often important employers in important communities.
States are not exactly cavalier about those issues." And, even
without the Boren Amendment, Vladeck said "there are still plenty
of other laws that will enable the government to ensure the
quality of the Medicaid program and patients' access to it." Que
reports that Vladeck said "there is another good reason to
repeal" the Boren Amendment. "Over the years, hospitals and
nursing homes have used the law to challenge payment rates in
court. That has led to a rash of lawsuits that have cost the
states even more," according to Que ("All Things Considered,"
5/20). Gov. Wilson said that in California alone, the repeal
could save the state "hundreds of millions of dollars"
(COPLEY/UNION TRIBUNE, 5/20).