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 more than 300 members with advocacy for robust and sustainable federal support. Our accomplishments include:
Stopping Threats to the Safety Net
America’s Essential Hospitals vigorously fought multiple bills to repeal the Affordable Care Act (ACA) and make draconian cuts to Medicaid—changes that would have jeopardized coverage for up to 32 million people. Association advocacy that helped defeat repeal legislation included numerous meetings with members of Congress, on behalf of and with member hospitals. We twice brought members to Washington this year, including in July for an emergency executive fly-in focused on swing-vote senators. The association also deployed one of its largest advocacy communications campaigns, including substantial paid and earned media on Capitol Hill and in states with undecided senators, and contributed to the Coalition to Protect America’s Health Care campaign in 12 states.
Ensuring Equity in Incentive Programs
America’s Essential Hospitals and its members achieved a major advocacy victory in December 2016 with enactment of the 21st Century Cures Act. The law requires, for the first time, that the Centers for Medicare & Medicaid Services (CMS) risk adjust penalties in the Medicare Hospital Readmissions Reduction Program (HRRP) to account for the socioeconomic challenges of vulnerable patients. Next, we will closely monitor how CMS finalizes the methodology to ensure regulators apply risk adjustment consistent with the statute. We will continue to promote ways to account for social risk factors, beyond dual eligibility status, in the HRRP and other programs, when appropriate.
Fighting Medicaid DSH Cuts
Since 2014, America’s Essential Hospitals has successfully delayed ACA cuts to Medicaid disproportionate share hospital (DSH) payments, saving essential hospitals $3.5 billion. Cuts through 2020 now are substantially lower than in the original law—down from $17.1 billion to $9 billion today. We also successfully fought for required annual federal reports on uninsured and uncompensated care for use as evidence in DSH funding decisions.
Medicaid DSH cuts remain scheduled to start October 1, 2017. We continue to work with congressional leaders and allied organizations to further delay or eliminate the cuts before that date. CMS recently issued rulemaking on the methodology for how the cuts will be applied. We continue to execute a regulatory strategy to mitigate the damage the pending cuts would cause by encouraging CMS to consider DSH funding’s vital role as support for essential hospitals.
Ensuring Access to Outpatient Care Services
America’s Essential Hospitals won partial relief from a damaging policy in the Bipartisan Budget Act (BBA) of 2015 that dramatically reduced payments to off-campus hospital outpatient departments established after November 1, 2015. As part of the 21st Century Cures Act, outpatient departments already under development at the time of BBA passage were excepted from the cuts.
While this relief is welcome, many essential hospitals still face economic obstacles to ensuring vulnerable patients and underserved communities have access to outpatient services. The association believes this site-neutral policy should exempt all essential hospital clinics, and we will continue to push for legislation to achieve this goal. We also will work for regulatory changes that protect essential hospitals and their vulnerable patients, including flexibility that would allow outpatient departments established before the law’s enactment to remain exempt from payment cuts if they relocate or change ownership.
Protecting the 340B Drug Pricing Program
The association and its members achieved a significant advocacy victory in January 2017, when the administration withdrew from Office of Management and Budget review potentially damaging 340B program “mega-guidance.” We vigorously opposed the guidance on several fronts, including on Capitol Hill, in regulatory agencies, and in the media, and successfully argued that it would severely narrow the program’s scope and leave many patients without access to lifesaving drugs. We believe these arguments resonated with policymakers.
But legislative and regulatory threats remain, including a proposal to redirect to Medicare a significant portion of hospitals’ 340B savings. We will continue our advocacy for policies that strengthen 340B and protect program integrity, while ensuring vulnerable patients and hospitals maintain access to affordable drugs.
Preserving Medicare DSH
The association has worked to preserve Medicare DSH payments for essential hospitals. As the Medicare DSH cuts increase, essential hospitals must stretch their resources further to continue ensuring access to care. 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 would impact essential hospitals.
Protecting Vital Supplemental Payments
In May 2016, CMS released the Medicaid managed care final rule, which prohibits states from directing supplemental payments under managed care arrangements. Earlier objections by America’s Essential Hospitals resulted in CMS giving states new latitude on supplemental payments—specifically the ability to establish provider classes (which could include public hospitals, teaching hospitals, or other state-created classifications) that could receive varying levels of supplemental payments. But CMS recently issued a final rule that significantly limits pass-through payments that the May 2016 rule had deemed permissible during a 10-year phase down of these critical lines of reimbursement. We will follow this regulation and educate members as developments arise.
Fostering Innovation in Medicaid Delivery
We support members’ understanding of and participation in Medicaid Delivery System Reform Incentive Payment program waivers. We advocate the value of these waivers to members and promote information sharing among members and key CMS staff. Educational components include extensive onsite programming at our annual conference, a dedicated annual Medicaid payment innovation and waiver summit, numerous distance learning opportunities, and research and policy briefs.
Raising the Visibility of Essential Hospitals
America’s Essential Hospitals stands as the nation’s foremost expert and trusted source on Medicaid and hospital care for vulnerable populations. Through proactive media campaigns, the association educates the nation about essential hospitals and the ongoing need to invest in their work to care for vulnerable patients. We also help our members make their voices heard in local and national reports on hospitals and health care. In 2016, the association further raised the visibility of its members on Capitol Hill by establishing the Essential Hospitals Political Action Committee.