MHA Today | June 30, 2017

June 30, 2017

MHA Today: News for Healthcare Leaders

twitter linkedin MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.


Herb Kuhn, MHA President & CEO
Count on fireworks over the weekend and into next week. Not the Independence Day variety, but the kind that are often on display at congressional town hall meetings.

As the Congress breaks for its holiday recess, there will be tremendous pressure — especially among members of the U.S. Senate — to meet with constituents and explain their health care bill. Although there’s been a lot of media coverage of the Senate’s Better Care Reconciliation Act since it emerged from the shadows, very few Americans seem satisfied that it does anything to produce “better care.” Senate Majority Leader Mitch McConnell of Kentucky may have created some breathing room by moving to amend and re-score the BCRA during the holiday recess. That doesn’t mean that Americans won’t be looking for answers.

As the weeks have passed since the U.S. House adopted the American Health Care Act, it has become clear that the legislation would create massive shifts in Medicaid costs and responsibilities from the federal government to the states. Although advocates for the bills indicate the effort is designed to make Medicaid “more sustainable,” reports on the impacts of the legislation point toward the opposite. Missouri and most other states are ill-prepared to take on the costs. And, states like Missouri that rely on provider taxes to support their programs would be especially hard hit under the Senate’s BCRA legislation, at least as originally offered.

Although the Affordable Care Act’s marketplace continues to have problems — including the potential for “bare counties” in Missouri and several other states — it isn’t imploding. It is, however, suffering from benign neglect. Federal policymakers are sending all of the wrong signals — that there’s a new policy environment coming, a lack of clarity on subsidies, and rhetoric about implosions. However, the alternatives in the AHCA and BCRA — including the opportunity for states to waive essential benefits and changes in the tax credit programs — are dubious replacements. These proposals could increase the upward pressure on prices, further distort the risk pool, and lead to a significant exodus from the marketplace.

Missouri has a lot at stake in the discussion. MHA will continue to issue state-specific research to help inform the dialogue at the federal, state and local level. Expect more next week and as the Senate’s bill evolves.

Earlier this week, I circulated copies of the letters I sent to Sens. Blunt and McCaskill on the Senate’s bill. Although the legislation may evolve, at this point it is hard to see how either the AHCA or BCRA would improve health care or support hospitals in Missouri. That’s a message I encourage you to share with both senators. In person is best. Absent that opportunity, we have a portal to send a message online.

Americans are paying attention. The vast majority oppose the Senate legislation.

The next version of the legislation will, without a doubt, be designed to bring more senators on board in an effort to get to a majority and a vote. Sen. McConnell faces a common Independence Day risk — that it will blow up in his hand.

Have a good holiday. Let me know what you think.

Herb Kuhn, MHA President & CEO

Herb B. Kuhn
MHA President and CEO

In This Issue
CBO Issues BCRA Longer-Term Projections
CBO Releases Economic Outlook And Federal Debt, Statutory Limit Reports
CMS Publishes Expectations For Reducing Legionella Risk
CMS Releases Proposed CY 2018 ESRD PPS Payment And Policy Updates

state and federal health policy developments

CBO Issues BCRA Longer-Term Projections

Staff Contact: Andrew Wheeler

The Congressional Budget Office released Better Care Reconciliation Act of 2017 Medicaid spending projections through 2036. According to the report, Medicaid spending would decrease 26 percent in 2026 and decrease 35 percent in 2036 as compared to the extended baseline. Because of data limitations, the CBO did not project insurance coverage changes after 2026; however, they comment that Medicaid enrollment would continue to fall relative to what would happen under the extended baseline. MHA has published an issue brief with additional details.

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CBO Releases Economic Outlook And Federal Debt, Statutory Limit Reports

Staff Contact: Andrew Wheeler

The Congressional Budget Office released a federal debt and the statutory limit report for June 2017. Previously, the debt limit was suspended, which expired March 15. If the debt limit remains unchanged, the Department of Treasury most likely will run out of cash in early to mid-October. The CBO also projects that the deficit this year will be $693 billion.

In a separate report, the CBO released an update to the budget and economic outlook for 2017 to 2027. It is estimated that throughout the next decade, consumer spending and growth in real growth domestic product is expected to increase at modest rates, deficits are expected to increase, and debt is projected to increase. Increasing deficit amounts in 2017 are attributable to an expected decrease of individual income taxes, declines in excise taxes, and decreased remittances by the Federal Reserve System to the Treasury. The CBO also projects that unemployment will continue to decline through 2018.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Publishes Expectations For Reducing Legionella Risk

Staff Contact: Jim Mikes

The Centers for Medicare & Medicaid Services has released a survey and certification memo that provides expectations for health facility water management policies and procedures to reduce the risk of growth and spread of Legionella. Facilities are expected to conduct risk assessments, implement water management programs, and specify testing protocols and acceptable ranges for control measures. Surveyors are instructed to begin verifying facility actions to reduce infections immediately.

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CMS Releases Proposed CY 2018 ESRD PPS Payment And Policy Updates

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released proposed payment and policy updates for the calendar year 2018 end-stage renal disease PPS. CMS claims that the proposed rule reflects a broader strategy to relieve regulatory burdens to providers, promote transparency, promote innovation and support the patient/doctor relationship. Spending for ESRD facilities in CY 2018 is expected to increase by $100 million for a total of $10 billion. CMS also projects that because of the quality incentive program, CMS will save $29 million in 2021. CMS has released a fact sheet, and MHA has published an issue brief with additional details.

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Did You Miss An Issue Of MHA Today?

June 29, 2017
MLN Connects Provider eNews Available
MHA Provides Compdata Survey Update

June 28, 2017
MO HealthNet Releases Third Quarter Webinar Training Schedule
Trajectories — Opioid Use Disorder
CMS Provides IPFQR Program Updates
CHP Offers Free Training Opportunity
MU Health Care Names New CEO

June 27, 2017
U.S. Senate Postpones Vote On ACA Repeal/Reform Legislation
CBO Releases Analysis Of Senate Health Reform Legislation
GAO Issues Report On Graduate Medical Education Trends

June 26, 2017
U.S. Senate Republicans Release New Version Of ACA Repeal/Replace Legislation
CMS Releases 2017 VTE Reporting Requirements

Consider This ...

More than one-third (36 percent) of the fireworks injuries in 2014 were to hands or fingers. One in 5 (19 percent) were eye injuries. An additional 19 percent were to other parts of the head.

Source: National Fire Protection Association