Federal policy update from the American Hospital Association
Welcome to the hospital finance podcast. You're go to source for information and insights that can help you. Stay ahead of the challenges. Impacting healthcare finance and now the host of the hospital finance podcast. Michael Pass Naughty Naughty and welcome back to the hospital. Finance podcast of CARE is always a major issue at the federal. Today I'm joined by Eric. Rasmussen of the American Hospital Association for update on what to expect from Washington. This year. Eric Works in the Federal Relations Department of the American Hospital Association as Vice President of the advocacy and public policy group. Eric is responsible for representing. Aj's interests before the US Congress. His primary goals are to promote hospitals interests with primary congressional committees. That have the greatest importance to hospitals Eric. Welcome to the show. Thanks Mike. I'M TO BE HERE. It's a you've got a good crew Listen to this podcast. I'm happy to get a few minutes with you. We were talking before the show and you had a rather rather extensive presentation that you gave earlier this year looking at a variety of federal issues so We're going to go through just a few of them here on the show today. 'cause I know we could be on for for quite a while if we did the mall But Watch start out by giving US yeah. Let's once you start off by giving us just a brief overview of the two thousand twenty congressional agenda and what they're looking at related to healthcare got it so the congressional agenda is going to be dictated by two days this year by a May twenty second and by November second November second of courses the presidential election. Everything's geared towards that but may twenty second is the less known date at the end of the last congress The Congress thought they were pretty close on two big issues on finishing legislation on surprise billing and on a drug pricing and so they had a package of must pass healthcare extenders. Things like Medicaid dish cuts funding for community health centers and a number of other dogs and cats and so rather than simply date those things with the rest of the federal budget which is through October. I decided to put those things on on a time. Line of May Twenty. Second which provides the mid-year must pass bill And as if you ever listen to Speaker Pelosi you'll You've you've learned that getting something to the. Us Senate is very very hard and frustrating but this package has to get through the US Senate by May Twenty second and so. That's a different date than usually happens. And so because those must pass things gotta get done by. May Twenty second other things are going to get onto that train. And the Congress want leaves Congress WanNa get a surprise billing and drug pricing into that or one or the other of those bald but they may only be able to get one and then they'll be They'll be what. I usually call ornaments on Christmas tree because this usually happens around Christmas time But it's near Memorial Day so it's probably like crap to put in the back of your car for the family vacation but other legislative Things get tacked onto a must pass bill and so there. There could be other things in the healthcare space get added on to it and there could be If they're pay for issues if they've got a raise money let's say they want to do something surprise building but it will cost money. Then they've got saves the money somewhere else so cuts could pop up in other areas And so that's the general agenda things are targeted through twenty second And so with the President's budget coming out at the dominoes are going to start to fall and we're GONNA have a very busy next four months. Great let's let's dive into some issues. That are specific to hospitals. That are that are out there much. Tell us a little bit about what might be coming. Related to Medicaid dish so Medicaid dish that they delayed the cuts to Medicaid. District May twenty second. So you may recall Medicaid dish It was kind of tied. In the to Medicaid Expansion Medicaid didn't end up expanding and so we have gone to the congressman said. Hey since Medicaid didn't expand everywhere in the way that you planned these discounts like. It's unfair to keep them going. Medicaid dishes get cut by four billion dollars in twenty twenty and then by eight billion dollars a year in twenty twenty one to twenty twenty five. So they We're very glad that delaying of the Medicaid dish cut has gotten extenders package where they've they realized they have to pass it. The issue is They can I mean it expires on. May Twenty seconds so technically on May twenty third. The full Medicaid dish supposed to go into effect. No member of Congress wants to go to their local hospital. They're know they're dish hospital and say. Hey you treat the poorest of the poor and thickest thick and we're GonNa cut you by hundreds of you know of millions of dollars And so we think that Congress wants to do the right thing politically and could they do have a heart And so the challenge becomes. Where does the money come from and Making sure that that stays with that extenders package of must pass that. It doesn't fall out of the package okay. Great and what do you think might change around site neutral payments? That's been an issue for a little while now as well yes I neutral. It's been an interesting thing because It's neutral is pay for or in other words. It's something that cuts spending and so congress can spend other things and members of Congress like spending things on things they like They're like a kid in the candy store so Site neutral is something that you can also turn a dial on it So you can start with a small site neutral amount and then you can ramp it up. and neutral for listeners are aware. There's there's the concept that you pay the same amount for a service regardless of what setting it's in so for an evaluation of management or visit if you pay thirty dollars for that in a doctor's office it should be paid thirty dollars in the hostile. Our opposition to that is is because Hospitals all the it all the studies show hospitals. See The sickest of the sick. We see a sticker population a poor population. We see an older. Our patients are more likely new. Medicaid or Medicaid Medicare dual eligible so And we also see patients twenty four hours a day And so like we see a more expensive patient. And that's why Medicare in its wisdom over. The years is that we will pay a higher amount at hospitals and physicians offices and part of that's also because doctors offices literally having a third of the cost of RS and everything They laughed lifespan. From nine to five we have be twenty four hours a day. We have to have surgical suites and a hand specialist on call and ambulance services all the things that make a hospital a hospital and so say neutral cuts are challenging for us like almost an existential level. 'cause they're saying Okay Hospital. We want to pay you like physician's office and we're not decisions office. If if you pay hospitals like physician's office you'll get you'll get a physician's office and you won't get all the things that we've decided we want to have in this country and so that's the problem with Satan neutral generally What could change? They can always dial things up on site neutral. So the president's budget's out on February tenth Last year but last year's budget proposed making site neutral payment for more and more services currently on campus hospital and outpatient facilities that were operating before December of two thousand fifteen get to retain that outpatient payment amount And the president's proposed changing that In fact he tried to do it by regulation and we sued them in one And so we're always worried that more site neutral payment could pop up in the budget or that Congress could turn a dial and raise you know three five ten twenty billion depending what they need the various site neutral payment Changes so it hangs like a spectre over most muss pass bills for us. Great Explanation Eric. Why don't we shift a little bit and talk about the election Couldn't have y'all without without looking and looking at something like that so medicare for all. I know it's something that's been talked about a lot. We've we've talked about it on the show before And it's likely to get some airtime. The election cycle heats up where we're at right now. Already think this is going. Were what nine months from the election? and Yeah. Medicare for all Is An interesting component Of the debate so You know we're still because of Iowa Kind of screwing the Pooch We had the drought that we've had usually have in a presidential election. So we're going on to New Hampshire and South Carolina and so usually in a presence in a primary both teams Go TO THEIR WING AREAS. So Democrats can be more liberally. Republicans campaign more conservatively. The comeback for the general to the center Medicare for all is going to be part of that. The thing is that Medicare for all means different things to different people. If you look at the debate stage you know Medicare for all for Sanders and Warren? Truly means Medicare for all like it gets rid of private insurance like it makes it illegal. And everyone's in actually gets Medicare to and it puts everyone in Medicare light system But then if you're Joe Biden. Her people Medicare for all looks a lot. More like the It's You know a public option standing alongside The private pay you and so and there's everything along that spectrum from from Warren to boot `age So in the elect But because Warren and sanders have been around for so long they're not gonNA attack back to the center. The Way in traditional presidential candidate does so if senators sanders warn win the nomination. Then I think the general is going to be a very clear dichotomy between A true Medicare for all which is again private. Pay would be gone so if you enjoy blue cross. Blue Shield plan is over. You're getting tossed into Medicare That versus president trump and the vision he laid out in a state of the Union which people may not agree with but He thinks that that healthcare is a winning issue. If he's running against sanders war it was Biden herbage and they tack back to the center of the political world. The way most presidential candidates do then I think healthcare becomes less of a big issue Because you're tinkering with the relative edges rather than kind of overthrowing the entirety of of Of the healthcare world That we the AJ. I should then for full disclosure. We we do not support we oppose Medicare for all And there's a million policy reasons but the easiest way to explain it is healthcare's between one fifth and one six the economy. It's it's a significant portion of what happens in this country it would be less disruptive to To for the government to take over the TV film automaking and vacation industries and they all run. That would be less disruptive than taking over the healthcare system and It's a I mean we'd see massive layoffs. We'd see it would be a really really life changing. That'd be like saying you're moving to Mars next year We don't know what we don't know about how crazy it would be. It's certainly a huge huge undertaking. Let me talk back to something that you you touched on a minute ago because know in a lot of the surveys and the polls that I've seen and other guests that we've we've talked to about this Pretty consistently healthcare comes up at the top of of of voters concerns. I mean really just above almost everything else And I'm I'm wondering you know how. How will the candidates ultimately respond to that? Will they treat it with the same level of importance that voters do or do you think they're going to look for other issues to focus on and this'll be somewhere in the mix but but not at the top of their list as it? Is Maybe for for the voting public? Yeah it'll be interesting. A lot of I think part of the depend on what gets done by. May Twenty seconds And I should mention in that may twenty second Rural Issues It's Senator Grassley chairs. The Senate Finance Committee is his last year's chairman of the Senate Finance Committee and he was like to get something done on rural health care and we would as well On something that And so that's a priority that mentioned earlier but that rural health issues will come up in the election for those rural states As you see certain or more than play like Iowa Ohio Arizona Nevada some of Purple States have got big rural areas. That's going to be an issue if Berle stuff gets done by. May Twenty second becomes less of a presidential issue. If it doesn't then it becomes a high issue and then from there you've got the big things And you can you come see what you know from the President's state of the Union 'cause he does polling Before he goes and gives that speech was going to pop up and surprised billing. I'm sorry not surprised. Billing drug pricing is going to be a big issue Most Americans are sick of paying Preston Drugs And most don't can't fathom why a drug cost you know five thousand dollars a month for these little pills and so I think that's going to be a big issue. I mean you've got the the standard bearer of the Republican Party is saying we have to cut drug prices. He's saying essentially the same talking points that NC Pelosi have so I think it's going to be an issue during the campaign where people are going to want that to get done other. GonNa want to like people who care about Like that actual healthcare Pocketbook issue And then other things expect. I think it's GonNa be interesting to see how Medicare for all plays out based on who the Democratic nominee is I think we've seen some messaging that the president's GonNa probably have he's GonNa call anything like Medicare for all socialism and so. I think that'll be a fairly black and white Type of debate Even if it's shouldn't be And then yeah I think both it's GonNa be interesting. I think both sides will focus on healthcare because they think it's a winning issue. It's been which is unique if you look at the twenty ten election Republican at right after the Republicans focused on healthcare because it was a winning issue for them. People were concerned about the ACA. Didn't know it was going to happen. That had success with tea party movement in the summer of twenty ten and then boom Republicans sixty six seats in the house like a historical Wave and then Democrats in two thousand eighteen. They go out and they talk about. Oh those Republicans. They wanted to repeal your protections on preexisting condition. So they made twenty eighteen about healthcare. Now that's debatable twenty eighteen that electric probably more about Donald Trump and the coming elections probably more about donald trump but They're both but both Democrats and Republicans think healthcare is a winning issue for them in twenty twenty that's going to be the biggest proxy war between trump and Hillary runs against And especially if it's one of the Senators Sanders or Warren is going to be a real real different Policy Debate And so it's GonNa be fascinating either way And Health is GONNA come up a lot either way And so you know it's going to be it's GonNa be a good one you bat and we'll be looking forward to may twenty second and seeing what the first steps are here as we look at healthcare in two thousand twenty Eric Conversation Did want to ask you where listeners can go if they'd like to learn more about. Ha and what you do with regard to advocacy and public policy. Well the age org website is a great place to go to for for all of our stuff but You can follow us on twitter or on facebook I don't know if we have a snapchat in yet but we'll get there mentally but So yeah false on twitter And and you can find things on H. At Org we also put out a daily age news every day. And so if your folks aren't getting that just ask someone they can call it. The friendly neighborhood Aj outposts we can get them signed signed into that or some of their facilities probably already getting it And so that's the easiest way is just have that email pop into your inbox. It takes sixty seconds to read at the end of every day. And that tells you what's going on in the hospitals base so would be the thing to do. Just get on that email list rage in is thank you. Eric you welcome. Thanks for having me. And we have our annual meeting coming up in April and so folks haven't registered yet but he's going register for the h annual meeting I I like working with the hospitals because it's like It's working for a bunch of do gooders. It's everyone in April's up. Thanks for having me and I'll talk to you next time if you have a topic that you'd like us to discuss on the hospital finance podcast or if you'd like to be a guest drop us a line update at Bessler DOT com. This concludes today's episode of the hospital. Finance podcast for show notes and additional resources to help you and enhance revenue at your hospital. Visit Bessler dot com forward slash podcasts. The hospital finance podcast is a production of bessler smart about revenue to nations about results.