More Uncertainty for CD4 Rural Hospitals
It’s been a good news/bad news week for rural Coloradans when it comes to Health Care. The relief enjoyed after the Colorado State Legislature found a compromise to allow Health Care revenue to grow may be short-lived. [See Democrats Rescue Rural Hospitals.] Events at the Federal and State level make it almost impossible to anticipate what health care availability and affordability will be like in rural CD4 in the coming years.
The National Scene
The House of Representatives passed its ACA repeal bill, the American Health Care Act, on May 4, 2017 with a popular approval rating of only 17%. A celebration was held in Congress, but he Senate announced it would form a committee to write its own law. Colorado’s Cory Gardner sits on the 13-man (that’s right, all men) working group tasked with drafting the bill. Neither the Senator nor his staff have been forthcoming to Coloradans about the process.
As late as June 6, the New York Times was reporting that, with only 30 legislative days remaining before the August recess, the chances of the Senate finding 52 votes for any bill was rated by Senators like Lindsay Graham as slim. Then Mitch McConnell had lunch with the Republican Senators. They emerged saying that the bill is on a fast track and predicted passage before July 4.
Nobody outside the working group and the Republican leadership had seen the bill. Speculation runs that it is similar to the House bill but rolls back the Medicaid Expansion at a slower pace, and somewhat strengthens protections for patients with pre-existing conditions. McConnell announced that there would be no readings or committee hearings until the bill is ready for a vote. That was the bad news.
Then on June 14 the Washington Post reported that Trump met with 15 Republican Senators behind closed doors and announced that the current bill is, among other things, “mean.” He directed the Senate to improve it. As yet, there’s no clarity on what this means for McConnell’s fast track plans. If pressure from the White House forces additional softening of the bill, that could be good news for Colorado, which has enrolled over 420K people in the expansion, out of over 1300K total Medicaid enrollees.
Here in Colorado
Anthem Blue Cross Blue Shield is contemplating withdrawing from the Individual insurance market in Colorado, citing uncertainty due to the ACA repeal fight and doubt as to whether some Federal subsidies will continue even in 2017. For fifteen Western Slope counties, this would mean there is no provider on the Exchange. Here in CD4, every county is served by at least one other provider, but an Anthem withdrawal leaves some with only one option. An announcement by Anthem is expected next week.
In an interview first broadcast on June 8 on Colorado Public Radio, Governor John Hickenlooper indicated that Colorado needs to hold itself to the standard of ensuring at least one provider in every county. He suggested the state might partner with a nonprofit group such as Kaiser Permanente for a rural expansion. He denied, however, that the state is already in negotiations with Kaiser.
Conditions on the ground in CD4
As we know, the Sustainability for Rural Colorado bill guarantees adequate funding for Rural Hospitals through fiscal 2018 and beyond under current Federal law. However, cuts to Medicaid Expansion, or a major Medicaid restructuring as a provision of the AHCA could put rural hospitals back at risk.
In tiny Hugo, residents believe that Lincoln County Hospital will close if Medicaid benefits are cut. Already, the hospital only provides Level IV trauma care, meaning that serious trauma patients can only be stabilized and transported to a better-equipped and staffed facility. Factors like this are what makes conventional health insurance so costly in rural areas. For primary care, residents are known to drive over 100 miles to Brush in Morgan County.
Anecdotes like this make the establishment of state-subsidized Kaiser-style nonprofit clinics seem very attractive. However, as we know, even with the Provider Fee restructuring, the Colorado legislature is limited in its ability to find new revenue for such projects, no matter how badly they are needed.
To learn more
http://www.kff.org/medicaid/
http://www.denverpost.com/2017/04/23/how-colorado-hospital-provider-fee-works/
Originally published in The Weathervane No 4 on June 15, 2017. [Subscribe]
