HIDA’s Health Reform Update

Edition: January 2013 - Vol 21 Number 01
Article#: 4157
Author: Linda Rouse O’Neill, VP, Govt Affairs, HIDA

Welcome to 2013. New members of Congress formally begin their duties this month and now that November’s voting buzz has died down, what do election results mean? Well, it means your vote counts. Dozens of elections were won by a narrow margin. In fact, two House of Representatives races did not have a certified winner until early December. But beyond your vote, your involvement counts. Through its PAC, HIDA supported 14 members of Congress up for reelection – 12 will be returning in January.

In the Senate, Democrats gained two seats, expanding their majority to 55 (Republicans have 45) and keeping control of committees. Democrats also gained seats in the House (there are now seven more Democrats for a total of 201). However, Republicans kept the majority in the House (233 total) and maintained control of committees.

New members will have to act fast to get up to speed on complicated issues sure to factor in quickly: some of the thorniest being America’s ongoing debt and tax issues as well as health reform implementation. With the narrow margins in both chambers, stalemates on contentious issues will continue.

Both parties are already looking ahead to 2014, when Senate Democrats have 20 members up for reelection compared to only 13 Senate Republicans. In the House, members are up for reelection every two years, so expect all seats to be contested.

2013 is a big year for hospital reimbursement tied to infections. That concept isn’t new, but now that Value Based Purchasing is in full effect as is Medicaid policy for preventable conditions, providers face layered financial implications. Conditions related to surgical site infections and catheter associated urinary tract infections are penalized multiple times. Come Oct. 1, 2014, these same infections may face an additional 1 percent cut under health reform.

Add to that higher penalties for readmissions related to heart attack, heart failure and pneumonia that Medicare deems “excessive.” More than 2,000 hospitals will likely see a penalty – estimated to total $280 million in FY2014 alone – with hospitals in New Jersey, New York, D.C., Arkansas, Kentucky, Mississippi, Illinois and Massachusetts hit harder than others.

What does it all mean for you? Providers will have intense focus on improving outcomes and will be looking for your help. Provide product information that includes clinical studies demonstrating why items are the right fit for customer needs.

The new year also brings deadlines for big programs related to health reform – health insurance exchanges, Medicaid expansion and benefit packages – as the White House kicks into high gear to implement health reform. These three elements are keys to getting more people health coverage. States who choose not to create their own insurance exchange – providing an option for residents to “shop” for coverage – will have access to a federal exchange.

The expansion of Medicaid alone is estimated to bring 11 million new beneficiaries by 2022. Medicaid expansion is one of the law’s provisions that the Supreme Court weighed in on. Justices ruled that the federal government cannot penalize states that do not expand Medicaid eligibility, leaving the program’s expansion in the hands of state governments. Ten states have already said they will not expand. Benefit packages are big news for employers who may see benefit pushing their employees to health coverage through the insurance exchanges, Medicaid or other options, which will save companies substantially.

You can visit “health reform” at HIDA.org for more details.