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Kirby: Hospitals, Public Need Health Reform

The State Newspaper

Thursday, Feb. 04, 2010

I wonder if Scott Brown will ever accomplish as much as a sitting U.S. senator as he did on the day he won the election. And how ironic that Ted Kennedy’s death has had such an adverse impact on health care reform – the very issue about which he was so passionate. This debate continues to be the best civics lesson the American people have witnessed in decades. Every time I speak on reform, the primary fascination is with the political process, and for good reason.

The day after the Massachusetts election, I was in Washington for a meeting of my counterparts from across the nation. That morning’s Washington Post contained two headlines that suggest that the near-term future for hospitals looks very different than it had just 24 hours earlier. The implications of the primary headline are obvious: “Republican wins Kennedy’s seat.” Health care reform, like all other Obama initiatives, is seriously threatened now that there are 41 Republicans in the Senate. Simply stated, Republicans can now filibuster undesirable legislation, and Democrats can’t be assured of mustering enough votes to limit debate.

The secondary headline was more ominous for hospitals: “Democrats cut deal to form debt watchdog.” Sounds pretty innocuous, but it isn’t. The first two sentences of the article are as clear as anything I can write: “Faced with growing alarm over the nation’s soaring debt, the White House and congressional Democrats tentatively agreed Tuesday to create an independent budget commission and to put its recommendations for fiscal solvency to a vote in Congress by the end of this year. Under the agreement, President Obama would issue an executive order to create an 18-member panel that would be granted broad authority to propose changes in the tax code and in the massive federal entitlement programs – including Medicare, Medicaid and Social Security – that threaten to drive the nation’s debt to levels not seen since World War II.”

Together, these headlines signal a grave threat to the hospital community. The threat of a double-whammy: health care reform doesn’t pass, and a deficit reduction commission is established to revise the tax code and modify (read cut) Medicare, Medicaid and Social Security. The net effect would be reductions in Medicare and Medicaid reimbursement without any increase in the number of Americans who have health insurance. More losses from government payers to be shifted to anyone else who will absorb them. If anyone else will absorb them.

This unhappy scenario has motivated the American Hospital Association, the Federation of American Hospitals and the Catholic Health Association to support federal reform legislation even though it’s not perfect. The best defense that hospitals will have against major cuts in a deficit-reduction environment will be the fact that Congress already has decided how to reconfigure Medicare and Medicaid. Without reform, our best argument goes away, and we just try our best to fend off cuts to Medicare and Medicaid.

It’s anyone’s guess what happens next. Democrats could try to use parliamentary maneuvers to push through a narrower version of reform, try to somehow pull in some Republican support, start all over, or simply walk away from reform.

Health care cannot be successfully reformed in stages. We can’t bar health insurers from refusing to cover people with pre-existing conditions without offering them more healthy customers to help cover the added risks; that is why an individual mandate is part of the current legislation. And we can’t force people to buy insurance when they have no money to pay the premium; that is why premium subsidies and Medicaid expansions are included. And hospitals can’t continue to care for a growing number of uninsured patients without shifting those costs to insured patients and their employers; that is why we can’t live with the status quo.

Not so long ago, experts of all political persuasions agreed that something has to be done. If Congress fails to come to some agreement on meaningful reform, our nation’s health care problems will continue to grow until our fragile system topples from its own weight.

Mr. Kirby is president of the S.C. Hospital Association.