fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

“Nontraditional” State of the Union Offers Opportunities on Health Care

January 11, 2016 | Chip Kahn

Category: Affordable Care Act, FAH News, Financing, General, Health Care Delivery, Insurance, Legislation, Media, Medicaid, Medicare, Pharmaceuticals, Quality

“Nontraditional” is the word many people are using to describe what we will hear during President Obama’s final State of the Union address. Instead of outlining a laundry list of issues, it is thought that he will focus on his past successes and then lay out an agenda that goes far beyond his final year in office. One that will almost assuredly include some aspects of health care.

At the top of the list needs to be improving and broadening health coverage and access to quality care.

Presumably, this starts by expanding Medicaid. The President should rally the American people to put aside partisan politics and ensure our country’s most vulnerable have access to health care, regardless of the where they live. The President should reiterate his Administration’s “open for business” philosophy when it comes to finding state-based solutions for Medicaid expansion.

With the end of open enrollment just a few weeks away, the State of the Union is also an important opportunity to reflect on the true success of the ACA, which makes coverage affordable for so many individual Americans and their loved ones. Millions of previously uninsured now have the health care they so desperately needed; however, millions more remain without insurance – even though they qualify for subsidies. The President speaking the right words could spur people into getting the information they need to enroll in and retain health coverage.

However, I certainly hope he doesn’t leave funding out of this discussion. To make sure the new coverage policies, as well as existing Medicare and Medicaid programs, are effective, we need to preserve patient access to quality hospital care – meaning no further hospital cuts. Further reductions in Medicare and Medicaid on top of those made over the last seven years will threaten the care that patients expect and deserve and make it more difficult for hospitals to meet the needs of their communities.  Since 2010 alone hospitals have been cut nearly $158 billion in ten year reductions, $35 billion in cuts enacted last year alone. The country needs to hear the President stand up for patients and call for a moratorium on any further hospital cuts.

The skyrocketing price of prescription drugs is likely on his agenda. The growing cost of medications, new and old, brand and generic, has created hardship for families and made it more difficult for healthcare providers to offer needed medicines and, for individuals, employers, and states to afford them. The President should use the “bully pulpit” to discuss advancing market-oriented solutions to the drug pricing problem.

But this address also provides an opportunity to talk about something many are afraid to mention – mental health. Millions of Americans struggle with mental health and substance use disorders and we need a healthcare system that meets their needs. Among other key improvements, President Obama should use this moment to modernize the way people are treated by coming out in favor of eliminating Medicaid’s IMD exclusion – a more than fifty-year old requirement that is out of step with the needs of today’s Medicaid beneficiaries.

The Administration has already moved in this direction, but thanks to the ACA’s Medicaid expansion there are new populations looking for new treatments in the right setting. It is vitally important that we move aggressively to make sure mental health treatments are on par with the services available for their physical health.

Further, our hospitals are committed to the success of alternative models of health care payment and delivery.  Across the country we are engaged in testing innovative care models developed by CMS’s Center for Medicare & Medicaid Innovation.

That being said, I hope the President will recognize the challenges of transitioning from fee-for-service to value-based payment because they are numerous and complex, and will require time, experience, and significant investment by both the public and private sectors in order to succeed.  I believe moving too fast, mandating too much, and limiting flexibility and the room to realign is counter-productive, disruptive, and could harm patient access to a fragile and fragmented health care delivery system. 

President Obama has a chance during this speech to set a course on an array of policies that will lead to more patient focused, fiscally responsible health care, I hope he seizes it.