BY KATHY KAHN
What to expect in the New Year was the question put to Kevin Dahill, president of the Northern Metropolitan Hospital Association (NORMET), at the Rockland Business Assocation (RBA) luncheon December 15 at The Crowne Plaza in Suffern.
With 50 percent of the funds New York’s hospitals receive coming from Medicare and Medicaid, hospitals and physicians’ groups are continuing to band together to offset expenses and keep revenues and expenses balanced.
“There is a lot of consolidation going on,” said Dahill. “As far as the reimbursement system-the fees paid for services provided—it’s generally agreed that whatever kind of government—Republican or Democrat—we are going to see some changes made. We’re not as focused on the Affordable Care Act itself, because we know something’s going to happen. ACA contained directives, including getting more people coverage. In New York State, 2.8 million people were registered and 2 million of those who registered are now on Medicaid. In Rockland County alone, one out of three people is on Medicaid.”
Unlike the pitfalls in “donut holes” and limited preventative services Medicare offers to those who can only afford the Part B minimum premium, Medicaid is free for the person who qualifies. It covers doctors, specialists, emergency room visits, eyeglasses, dental (including orthodontics), prescriptions and transportation to doctors and hospitals, including ambulance service. It is a program designed to help the neediest, but at least in New York, it has also become a “godsend” to the greediest companies who learn how to maximize profits from the system.
For those who don’t qualify for Medicaid or Medicare, they are mandated to buy private health insurance or face tax penalties. Under the ACA, many have seen their premiums double in the past year, leaving them to amend household budgets and prioritize purchases to make up for the increasing cost. Naturally, this has caused a disturbance among the voting public. “There are many in Congress chomping at the bit to repeal and replace the Affordable Care Act, since a new administration is coming in,” said Dahill.
During his campaign and the post-election season, President-elect Donald Trump has softened his stance on Obamacare but has definite plans to change it, if not replace it. With a Republican-controlled Senate and House of Representatives, Americans will see the stagnation in Congress come to an end-whether they like it or not.
“They (Congress) never passed a budget last year,” said Dahill. “Our country is working on a ‘continuing resolution,’ and that affords a new administration an opportunity to pass a Budget Reconciliation Bill.” Dahill expects to see Obamacare– “1,761 pages long–passed by a Congress that was not 100 percent sure what it was signing the American people up for”– to be changed after Trump takes office.
Dahill predicted a new wrinkle for state Medicaid programs: Medicaid Block Grants. “Most of the expenses of Medicaid are borne by federal benefits but with new leadership in place, Congress will put a cap on how much providers will get. The day of reckoning is coming. We do know U.S. Rep. Tom Price (R-Georgia) is Trump’s nominee for Secretary of Health and Human Services…he is an orthopedic surgeon and outspoken opponent of the Affordable Care Act.”
Price, currently Chair of the House Budget Committee, sponsored the alternative “Empowering Patients First” Act in 2009 and has been championing the legislation every year since first introducing it. It was and continues to be the most popular Republican answer to creating a national health care plan.
With 47 percent of New York’s budget dedicated to the Medicaid program, “If hospitals appear to be schizophrenic, perhaps you can understand why,” said Dahill. “”50 percent of the ledger is government, and 50 percent are those who buy insurance. Hopefully, we can all advocate for a change for the better.”