Hospitals’ policy priorities beyond ACA repeal

While the debate over repealing, replacing or repairing the Affordable Care Act (ACA) is dominating discussion of healthcare policy in Washington these days, the American Hospital Association (AHA) has several other items on its advocacy agenda for 2017.

Speaking to the American College of Healthcare Executives (ACHE) Congress in Chicago, AHA President and CEO Rick Pollack and Executive Vice President Tom Nickels said there are still areas of concern for hospitals, even with repeal-and-replace supposedly on the back burner. Some of them are rehashes of Obama-era worries, like tax cuts and the federal budget leading to changes to site-neutral payments or graduate medical education support to offset other priorities.

Not all of the President Donald Trump’s moves will put hospital lobbyists on defense, however. The AHA leaders said if Trump wants Congress to tackle a major tax overhaul, the industry could benefit, particularly nonprofit facilities.

“There are three issues that affect hospitals and health systems in that debate,” Pollack said. “One is the status of charitable contributions, the second is the status of tax-exempt bonds and the third is the definition of community benefit.”

There are also potential pitfalls. Both Nickels and Pollack predicted there’d be discussion of “whittling down” provisions in the ACA affecting physician-owned hospitals within any tax reform debate. The AHA wants rules limiting physician self-referral “which was inducing increased utilization” to stay in place.

October 1 will be a crucial date for several of the association priorities. The Children’s Health Insurance Program (CHIP), the Medicare Dependent Hospital program and the low-volume adjustment for rural hospitals all expire on that date, with Nickels hoping those will all be tackled and extended together.

“I think that will certainly be part of the conversation as it relates to CHIP,” he said.

Pollack said the AHA will continue fighting the cuts to Medicaid disproportionate share hospital (DSH) payments made by the ACA, which have been continually delayed since the law was passed and Nickels was confident would be again. Restoring Medicare DSH cuts, however, has been a tougher sell than its Medicaid counterpart.

“It’s been, frankly, easier to persuade people that those cuts need to be restored than Medicare DSH,” Nickels said.

In broader terms, Pollack said the AHA is hoping for deregulation at HHS (as outlined in its letter to Trump during the presidential transition), along with action on rising prescription drug prices and protecting delivery system reforms made since the ACA was passed. Both AHA leaders think those reforms are safe under the new administration, even if a law it wants to repeal was their catalyst.

“It’s better for us to achieve efficiencies in the delivery system through changing it to improve care and rationalizing the way we deliver care, because the alternative to doing it in that way is the political default mechanism of ratchet, ratchet, ratchet provider cuts,” Pollack said.