AHA on healthcare reform: More positives than negatives
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The 27-page letter provides detailed observations on each bill's coverage proposals.
The House proposal expands coverage to 96 percent of everyone legally residing in the U.S., or 94 percent of all residents, while the Senate bill covers 92 percent of all U.S. residents. The AHA also said it supports starting coverage in 2013, as proposed in the House bill.
If the level of coverage can’t be offered at the level of the House bill, the AHA said, then “hospitals’ contribution to financing healthcare reform in the form of payment cuts should be reduced.”
In addition, the AHA wrote that it continues to advocate “coverage for all, paid for by all,” and that shared responsibility is critical to achieving comprehensive coverage.
“The AHA urges the conferees to make certain the final legislation balances a mandate for individuals to obtain coverage with a strong requirement that employers continue to participate in the provision of health care coverage for their employees,” the AHA wrote. “We support an employer mandate that provides strong incentives for employers to continue their historical role in providing health insurance to their employees.”
Consequently, the AHA believes the House bill—which provides a strong individual mandate tied to 2.5 percent of modified adjusted gross income—shows more promise ”for creating a balance between employer and employee responsibility." In addition, the AHA wrote, the House version “offers a robust framework in urging employers to maintain their participation in the health insurance system.”
As far as the public option is concerned, the AHA “strongly recommends” that Congress take the approach adopted by the Senate, which would create “state-based, non-public, non-governmental healthcare cooperatives and non-public, multi-state health plans.”
“These alternatives offer the needed opportunities for more affordable health plans while preserving market-based approaches with negotiated provider rates,” the AHA wrote. The association added that it supports the creation of health insurance exchanges—proposed in both the House and Senate versions--as avenues through which consumers can choose health plans to fit their needs.
The AHA also is urging that Congress adopt the Senate proposal to expand Medicaid eligibility to those at or below 133 percent of poverty, as opposed to the House version that expands it up to 150 percent of the poverty level.
“We support expanding Medicaid eligibility with federal financing for certain new populations,“ the AHA wrote. “As the program is expanded, however, we are very concerned about Medicaid provider payment shortfalls.”
According to the AHA, the Medicaid payment shortfall for hospitals amounted to $10.5 billion in 2008 and that Medicaid, on average, pays only 89 cents for every dollar spent treating Medicaid patients. “To expand Medicaid to even more individuals will exacerbate the already difficult financial situation of many hospitals given the much below cost rates paid by state Medicaid programs,” wrote the AHA.