2014: New Year, Old Challenges for ACA

Though the tormented roll-out of the Affordable Care Act is still fresh on the minds of most Americans, it’s important to note that the dark days of Obamacare are most likely over. The website is now working fairly smoothly, and people are finding that they are able to access healthcare coverage easier than ever before. And despite copious attempts at disruption, deceit and misinformation, even Texans are finding their way through the process to obtain health insurance. As the Texas Tribune notes, enrollments in the Lone Star State are actually moving as fast as areas that were more amiable to the law…

Texas enrollments in the online insurance marketplace created under the Affordable Care Act rose nearly eightfold in December, according to 2013 figures that the U.S. Department of Health and Human Services released Monday.

Texas ranks third in the number of 2013 enrollments following the troubled launch of healthcare.gov on Oct. 1. As of Dec. 28, nearly 120,000 Texans had purchased coverage in the federal marketplace, up from 14,000 one month before.

The number represents a tiny fraction of the uninsured in Texas, which has a higher percentage of people without health coverage than any other state. In 2012, more than 6 million Texans, about 24 percent of the population, lacked health insurance, according to U.S. census data…

Three-quarters of Texans who purchased health plans in the exchange in 2013 received financial assistance, according to the HHS data. That percentage, which is less than the median rate of 80 percent for the 36 states operating under the federal exchange, might have been larger had Texas expanded Medicaid to cover poor adults. Texans living below the poverty line do not qualify for subsidies.

Granted 120,000 enrollees is still far-short of the 6 million Texans that are in need of coverage, but it’s significant progress nonetheless. Try as they did, Governor Perry and Attorney General Greg Abbott did not destroy Obamacare. It’s in Texas, and it is here to stay.

But who suffers from the Governor and AG’s ACA malice? Texas’ poorest citizens and our hospital system by refusing the state’s Medicaid Expansion. There’s nothing the GOP can do to destroy Obamacre, so they’ve decided to turn their wrath onto their most vulnerable constituents. Directly from the Texas Hospital Association, here’s some insight into the bind that Perry and Abbott have created for the state’s already cash-strapped hospitals…

Unfortunately, the positive impact for Texas hospitals is diminished. The state’s failure to extend Medicaid coverage to the working poor or devise its own solution to reduce the number of uninsured leaves more than one million Texans with no access to affordable coverage options.

In addition, ongoing and new federal funding cuts result in significantly fewer resources for Texas hospitals to provide care for the uninsured.

–Hospitals already provide more than $5 billion annually in uncompensated care because of Texas’ high rate of uninsured.

–Reductions in Medicare Disproportionate Share Hospital payments began in FY 2012 and for FY 2014 alone are between $16 million and $19 million.

–The recent congressional budget deal will extend federal cuts to the Medicaid Disproportionate Share Hospital program that were intended as “pay-fors” for Medicaid expansion for an additional year through 2023.

–The budget deal also extends the two percent sequester reduction in reimbursement rates for Medicare providers (including hospitals) for two additional years from 2021 to 2023.

–The three-month SGR or “doc fix” will avert deep cuts to physician reimbursement but contains substantially lower payments for long-term care hospitals that serve patients with clinically complex conditions.

“Increased private insurance enrollment through the Marketplace is certainly good news, but with a million Texans remaining uninsured and reduced federal resources, Texas hospitals will shoulder a heavy financial burden,” said John Hawkins, THA senior vice president for government relations. “The state’s inaction on coverage for the working poor and new and continued funding cuts at the federal level are a real threat to Texas hospitals’ continued ability to provide the highest quality care to all who need it.”

That $5 billion of uncompensated care?? That’s what I refer to as Crisiscaid… basically the only option for people who have no health insurance. They go along, hoping and praying that everything is ok, but the moment they get sick or have an accident, their only option for treatment is to go to the Emergency Room. And if they don’t have thousands of dollars to pay the hospital for that treatment, the hospital loses money. This a problem statewide, but it puts a particular strain on our state’s rural hospitals… many of which are facing closure if Medicaid is not expanded.

As Greg Abbott stumps around the state for his Gubernatorial bid, he has yet to address the question of how he plans to save Texas’ rural hospitals without taking the Medicaid expansion. For all of these people that no access to health insurance, what does he want them to do? One simple vote by the legislature is all that stands in the way of affordable healthcare for millions of Texans. Hard-working doctors and hospitals would be empowered to care for more patients without worrying so much about their bottom line. erhaps someone should ask him these questions. Hopefully Democrats will find the courage to demand answers soon. 

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