The Impact of the ACA on Healthcare Safety Nets: A Case Study. Nadia Haj-Ismail MS4

Transcription

1 The Impact of the ACA on Healthcare Safety Nets: A Case Study Nadia Haj-Ismail MS4

2 Abstract After the Affordable Care Act was passed, there was concern that healthcare safety nets would become obsolete. However, looking at the examples of two very different states, Massachusetts and Texas, it is evident that these facilities are still very important to providing care to those who need it most.

3 Introduction Healthcare safety nets are facilities that provide medical care primarily to the indigent and uninsured. After the ACA was passed, there was debate about if these places would still be needed. Part of the ACA included steps to decrease federal funding given to hospitals that treat a disproportionately high number of uninsured and Medicaid patients. Also, given the unequal implementation of the ACA across the country, it was difficult to predict what role these facilities would have in the future. Massachusetts enacted major healthcare reform in 2006 and actually served as the model for the ACA. Texas refused the Medicaid expansion, which would have covered many indigent citizens, and also considerably limited outreach efforts to enroll patients.

4 Uninsured Rate, Source: Kaiser Family Foundation, State Health Facts

5 Thesis Statement Considering the diverse healthcare landscape across the United States, it may be hypothesized that in states where more patients became insured, safety net hospitals may play a less important role than in states that did not actively work to enroll patients or those that refused to expand Medicaid.

6 Literature Review Much public health research has been conducted, looking at how safety net facilities have fared since the ACA was passed. Overall, despite the differences in uninsured rates and outreach efforts to enroll patients, many hospitals and community health centers faced similar issues. Financial challenges Decreased reimbursements for Medicaid and planned cuts to Disproportionate Share Hospital (DSH) programs, along with decreases in state and local funding. Increase in patient load Patients tended to continue seeking care at safety net facilities even after becoming insured, largely due to supportive services that are offered (i.e. social work, addiction counseling, translation services). Newly insured Medicaid patients found that some private clinics/hospitals did not take Medicaid or charged too much. Governmental pressures The shift from fee-for-service to value-based care places on emphasis on quality of care and places more risk on healthcare facilities, which can be costprohibitive for some safety net systems.

7 Literature Review Looking at examples of healthcare safety nets in two very different states, it does seem to support that states that expanded Medicaid had more a decline in government funding than states that did not expand. Cambridge Health Alliance has had a negative profit margin for the last several years, although it has been slowly improving. Harris Health System has felt some financial pressure because of decreased funding and has had to cut back on some services, but has been able to breakeven in terms of costs and revenue. Have the benefit of having a strong tax base to support them which actually contributes the majority of the system s revenue.

8 Cambridge Health Alliance Source: Center for Health Information and Analysis, Massachusetts Hospital Profiles

9 Harris Health System Source: Harris Health Annual Report, 2016

10 Discussion Despite enacting the ACA, there is still much left to be desired regarding healthcare reform. Unequal impact across states leaves some patients at a disadvantage. Policy should be enacted that allows for more efforts to enroll patients. Healthcare safety nets have become more essential after the decrease in the uninsured rate. More patients are seeking care now that they are insured. Patients that had used safety net facilities while uninsured often choose to continue their care with familiar providers. Many private facilities are still refusing to see Medicaid patients or charge rates that are too high. Continued (and ideally, increased) financial support is important to sustain these clinics/hospitals that provide care for the most vulnerable patients. DSH payments should not be reduced to those healthcare safety nets that need the funding. As long as complex patients and patients with Medicaid continue to be shunted to safety net facilities, decreased reimbursements will unfairly target these places.

11 Conclusion Safety net healthcare systems are the saving grace for many uninsured patients and have continued to play an important role in the landscape of healthcare coverage despite the good intentions of the ACA. Healthcare costs are rising exponentially and there is a desperate need for a better system that will not only provide coverage for all, but will also control the price of that care. Physicians need to take a more active role in bringing to light the problems with the healthcare spending and encourage the public to put pressure on their government representatives. There needs to be a partnership between physicians and public health researchers, who have been the primary chroniclers of health disparities; they should both work towards the common goal of affordable care for all.