If I mention the name Tom Sawyer, your mind will probably take you to English class, Mark Twain, a family trip to Hannibal or scenes of life on the Mississippi from a bygone era. That’s not the Tom Sawyer I’m thinking about today. I want to share an idea from the lyrics of the song Tom Sawyer from the rock band Rush.
This week, MHA released the annual Community Investment Report. This year’s report, in addition to underscoring the essential contributions that hospitals make to support the communities they serve, provided a compelling and timely data point. For the first time in more than a decade, uncompensated care costs dropped between 2014 and 2015. Uncompensated care is still higher than it was in 2013. However, it’s no coincidence that in 2015, a growing number of Missourians had insurance through the federal marketplace.
The release comes amid action in Congress to modify the Affordable Care Act, and a promised strategy for repeal and replacement of the law by President Trump, who was inaugurated earlier today. We don’t yet know what “repeal and replace” looks like, but it’s clear that change is coming. That’s where the Tom Sawyer lyric comes in: “He knows that changes aren’t permanent. But change is.”
We all know that the Affordable Care Act has been controversial — it also has been transformational. Hospitals and the health care system have come a long way since the ACA was adopted in 2010. Subsequent legislation and countless regulations have pushed hospitals in new directions. Care is more coordinated, information has become more integrated and accessible, and value has become a central component of delivery and payment. None of this was easy. This progress must, and will, continue.
This year’s Community Investment Report underscores the influence of coverage on the use of resources to improve the health care system. The report finds that despite a drop in uncompensated care, total community benefit provided in 2015 was stable. This indicates that when hospitals have a reduced uncompensated care cost, they continue to invest in services that improve their communities. Think about the opportunities for individual and community health if hundreds of millions of dollars were available for targeted health improvement.
The new administration is expected to issue executive orders, and expand on their heretofore limited policy pronouncements about the future of the ACA, almost immediately. As we know from ACA implementation, real change will take time. However, individual health, and the stability of the health care system, hang in the balance.
Coverage will be a central issue in the replace effort. Health insurance, including Medicaid, can make a difference in individual health. That’s why the “replace” part of Washington’s deliberations is important. Replace signals both an understanding and acceptance that health care coverage is important and necessary. That’s critical for Missouri. The Community Investment Report shows that even with the improvements that have been made over the past few years, on average — every minute of every day, 365 days a year — an uninsured person is presenting themselves to a hospital emergency department in Missouri seeking health care services.
Since the ACA was funded in part through cuts to hospital payments, replacement should deliver either expanded coverage — which would be optimal — or a roll back of the cuts made to pay for it. Further, it is important that policymakers understand that the significant increase in charity care at Missouri hospitals — more than 450 percent increase throughout a decade — signals that growth in uncompensated care is unsustainable.
MHA is putting the opportunity to work. We’ve met with members of the federal delegation, and continue to work with state lawmakers to inform how change can be harnessed to benefit the state’s health care delivery system.
It’s clear the ACA isn’t permanent. However, recognizing that change itself is, gives us a clearer view of the options moving forward.
Let me know what you are thinking.
In This Issue
Herb B. Kuhn
MHA President and CEO
CMS Reminds Providers About MOON Implementation Deadline
Surveillance Report Finds Increased Flu Activity In Missouri
CMS Posts Additional Notes For Sepsis Abstraction
CMS Seeks Comments On Proposed Medication Reconciliation On Admission Quality Measure