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Our Advocacy Achievements

America’s Essential Hospitals is the voice for hospitals that care for people who face economic and social hardships. Our members also provide top-level trauma and burn care, and other lifesaving treatment; train health professionals; deliver comprehensive, coordinated care; and advance public health. We support our 300 members with advocacy for robust and sustainable federal support. Our recent accomplishments include:

Stopping Medicaid DSH Cuts

Since 2014, America’s Essential Hospitals has convinced Congress to delay more than $9 billion in cuts to Medicaid disproportionate share hospital (DSH) payments. Bipartisan lawmakers agree: These Affordable Care Act (ACA) cuts cannot be justified, given shortfalls in ACA coverage. The latest delay, in February 2018, stopped $5 billion in cuts in fiscal years 2018 and 2019. But without further congressional action, a devastating $4 billion DSH reduction will occur October 1, 2019. America’s Essential Hospitals is working with Congress now to avert that cut and find a sustainable way to support essential hospitals.

Protecting 340B Drug Discounts

In 2017, after the association stopped “mega-guidance” to severely limit access to the 340B Drug Pricing Program, federal regulators deeply reduced 2018 Medicare outpatient drug payments to 340B hospitals. The association rallied bipartisan support in Congress against the cuts and demanded that the government reverse course. But the cuts started, and the association and industry partners took legal action. In December 2018, a federal court ruled the government acted unlawfully, issued a permanent injunction, and requested briefings on remedies. The association asked that hospitals be made whole, and we expect further favorable court action.

This win was our second for 340B in 2018. The Department of Health and Human Services, spurred by another lawsuit with our industry partners, issued a long-delayed rule that requires manufacturers to publish ceiling prices for 340B drugs and establishes civil monetary penalties for noncompliance. This final rule brought much-needed manufacturer accountability to the 340B program. The association remains alert for, and ready to respond to, new threats to 340B.

Ensuring Access to Outpatient Services

In 2018, America’s Essential Hospitals aggressively opposed a Centers for Medicare & Medicaid Services (CMS) decision to expand site-neutral payment cuts to clinic visits at previously excepted hospital outpatient departments. Association staff directly engaged key administration figures, including Health and Human Services Secretary Alex Azar and CMS Administrator Seema Verma, and built support on Capitol Hill for a legislative remedy. Our advocacy resulted in a bipartisan House letter to CMS questioning the justification for the proposal and raising concerns about how it might affect hospitals and vulnerable patients. We also filed an amicus brief in an industry lawsuit to overturn the policy.

Demanding Reliable Hospital Ratings

After we raised concerns about the reliability and value to consumers of hospital star ratings, CMS delayed the July 2018 release of new ratings. The association then worked to expose flaws in the ratings methodology and demonstrate how the ratings harm specific types of hospitals. In early 2019, we and our industry partners met with key CMS staff to raise these issues, and we sent a joint follow-up letter. While the agency later published ratings, it also proposed changes to the program that respond to our concerns.

Preserving Medicare DSH

We have worked to preserve Medicare DSH payments for essential hospitals. We have strongly advocated a freeze on Medicare DSH cuts, which would give Congress time to study the structure, role, and need for Medicare DSH, as well as how the cuts undermine the important work of essential hospitals.

Leading on Social Determinants of Health

The association has effectively led conversations on social determinants of health and how payment models can account for these factors. In December 2018, we spoke with key leaders at the Center for Medicare and Medicaid Innovation (CMMI) about this issue. At CMMI’s request, we followed up that discussion with written comments on social determinants in the context of CMMI models. In our comments, we emphasized our members’ mission and the social determinants prevalent in their communities, including food insecurity and housing instability.

Fostering Innovation in Medicaid Delivery

America’s Essential Hospitals helps its members assess and participate in waivers and other evolving opportunities to foster Medicaid innovation. We advocate a leading role for essential hospitals as states work with managed care plans to tackle social determinants of health, leverage accountable care networks, and undertake other promising reforms. By educating our members through in-person programs, distance learning, and publications and helping them connect and share information with federal policymakers, we position essential hospitals to succeed in this new environment.

Sounding the Alarm on Threats to Access

America’s Essential Hospitals was the first and leading voice for hospitals when proposed immigration policies threatened to have a chilling effect on care for legal immigrants. The public charge proposal—to consider, for the first time, use of Medicaid and other federal aid in immigration status decisions—could cause many people to put off care until they become sicker and costlier to treat. It also could raise uncompensated costs for hospitals as immigrants forgo Medicaid coverage to protect their status.

Supporting Members in Their States

In late 2018, the association expanded its advocacy footprint by adding capacity to track state-level policy issues important to members. This state policy function includes a new, full-time analyst; dedicated website content; policy briefs; and other state-specific communications. Initial areas of focus include the 340B program, social determinants of health, the opioid crisis, telehealth, trauma care, and health care cost transparency; this list will evolve as new issues emerge.

Raising the Visibility of Essential Hospitals

Policymakers and the media turn to America’s Essential Hospitals as the nation’s foremost voice on Medicaid and hospital care for vulnerable people. We also raise our members’ visibility in Washington, D.C., through the Essential Hospitals Political Action Committee, Federal Action Network, Policy Assembly, and Government Relations Academy.

Learn More

Learn more about our work in Washington on behalf of essential hospitals and their patients. Contact us at or 202-585-0100.

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