Hospitals Brace for Medicare Changes

by Luke Jones  on Monday, Oct. 1, 2012 12:00 am  

Medicaid Expansion

The Medicare cuts have an upside, however: expansion to Medicaid.

"Those funds from the ACA are used to expand Medicaid coverage in the states," Lowman said. "We think expanding Medicaid to over 250,000 adult patients is critical to Arkansas."

"I think it's the most vulnerable part of our population," said Dr. Dan Rahn, chancellor of the University of Arkansas for Medical Sciences in Little Rock. "Right now, many individuals in that age group are not getting regular, preventative services or ongoing care for chronic diseases."

Rahn said about 37 percent of UAMS' patients use Medicare and 16 percent use Medicaid.

"The reason for that is we have obstetrics services here and adult services," he said. "Our pediatric services are over at Arkansas Children's Hospital, where they're about 60 percent Medicaid."

The Affordable Care Act originally punished states that did not expand Medicaid, but the same U.S. Supreme Court ruling that found the act's individual insurance mandate constitutional rejected the strong-arm approach to Medicaid expansion. In Arkansas, however, approving the budget to expand Medicaid will require a supermajority vote in the legislature, and some Republican lawmakers are balking.

Like Gov. Mike Beebe, Rahn is in favor of participation.

"If they do, it is 100 percent covered by federal dollars for the first several years; then it goes to 90 percent federal dollars," he said, "so Arkansas residents have a net benefit."

Rahn said that if Arkansas opts out, the state will lose dollars and still have large numbers of uninsured patients.

"I believe we can't begin to get the kind of improvements in value for the public until we can get everybody included in the system, everybody under the tent," he said. "Getting people access to health care in the right setting at the right time is a critical first step in redesigning and achieving these kinds of goals for the nation's health system."

Ultimately, Lowman said, hospitals will simply need to adapt.

"We just have to remain focused on clinical quality and aligning with physicians and being efficient," he said. "Those things aren't going to change, regardless of payment structures and public policy."



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