Hospitals: We want an ACA delay, too

Concerns persist as hospitals prepare for exchanges, payment cuts

In the wake of the Obama administration's decision to postpone the Affordable Care Act's (ACA) employer mandate, the American Hospital Association (AHA) is renewing its push to delay scheduled reductions to disproportionate share hospital (DSH) payments.

The Medicaid DSH payment reductions were included in the ACA on the assumption that the law’s coverage expansions would reduce a large portion of hospitals' uncompensated-care costs. However, the U.S. Supreme Court's ruling on the ACA allowed states to opt out of the Medicaid expansion, changing the math of coverage expansion.

Moreover, the administration announced last week that it would postpone the ACA's employer mandate for one year in order to address concerns about its reporting requirements. The mandate requires that employers with more than 50 workers provide affordable health coverage or face a fine.



In a statement, AHA President Richard Umbdenstock linked the delay to many states' refusal to expand their Medicaid programs. "The goal of the [ACA] was to extend coverage to the uninsured, which required a shared responsibility from all stakeholders," he argued.

Umbdenstock called on federal officials to postpone the looming cuts to safety-net hospitals, arguing that they would be unable to withstand smaller reimbursements if employers did not expand coverage for another year.

Hospitals rush to prepare for exchange rollout

Meanwhile, hospitals across the country are rushing to prepare for the launch of the ACA's insurance exchanges, despite lingering questions on how the marketplaces will work, USA Today reports.

"We are still waiting for a tremendous amount of information about how this is actually going to work," says Cleveland Clinic CFO Steven Glass. Hospitals are most uncertain about "what products will be offered through the exchanges," he says, adding that "[f]or providers that will translate into changes on who comes to your facility vs. other one."

Nonetheless, Cleveland Clinic is preparing for the anticipated increase in demand from insured patients by expanding its primary care services. In the last year and a half, the clinic has increased its number of primary care practices from 15 to 29 and added dozens of staff members. Similarly, the University of Chicago has opened a 10-story, 1.2 million-square-foot adult hospital to manage the expected influx of patients.

At Medstar Georgetown University Hospital, officials are focusing on a potential shortage of physicians that could impede patients' access to care. As such, the hospital has increased its call centers, moved to online appointments, and hired additional nurse practitioners, which they hope will alleviate the shortage (Flock, U.S. News & World Report, 7/3; Viebeck, "Healthwatch," The Hill, 7/3).


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