Gridlock Could Mean Few Health Care Changes

An OSF HealthCare leader with more than two dozen years of experience in governmental relations says a divided Congress will not likely move on significant health care reforms or reimbursement rates for Medicare and Medicaid. Those two government programs pay for health care for more than 80 million Americans.

Chris Manson provided state and federal health care legislative updates during a "Healthy Workplace" luncheon for area business and community leaders in Alton this week. Manson says with Democrats controlling the US House and Republicans in the majority in the Senate, he doesn’t expect any big changes.

“Where the Democrats in the House probably want to expand various provisions of the Affordable Care Act (ACA), the Senate would probably want to go ahead and kind of roll some additional provisions back so you have a conflict there that will really prevent anything from moving forward on the health care front,” he explained.

Manson predicts any changes could come from the president issuing executive orders such as changes he imposed earlier this year that allow consumers to purchase less-robust, short-term health insurance plans that typically cost less than ACA plans.

Prescription Drug Discounts For Hospitals

There is also concern that pressure from pharmaceutical companies could chip away at a requirement to offer drug discounts to eligible health care organizations that treat a disproportionate number of Medicare, Medicaid, and Supplemental Security Income patients.

Manson says the program Congress enacted in 1992 has been under attack by pharmaceutical companies. He’s concerned some of those lobbying efforts could affect the long-term future of a program designed to protect vulnerable populations.

“You have hospitals like here in Alton, Saint Anthony’s Health Center, that’s opening up a Cancer Center. It’s going to provide a lot of services to a community that otherwise wouldn’t have those services and part of that is because of the savings they’re receiving from the drug discount program,” he added.

Hospital Assessments for Medicaid Support Could Change

It’s not particularly exciting to talk about, but legislators were happy when this year they were able to negotiate a new Medicaid funding formula that resulted in $200 million new federal Medicaid dollars for Illinois hospitals. Manson says that formula sunsets in two years and changes could reward hospitals who have been transforming health care.

“The idea of transforming to better meet the needs of the communities we serve is something that’s really woven into our DNA and who we are. And, so if the state’s recognizing that and kind of going down that path and making sure that hospitals that serve those Medicaid patients are reimbursed that’s a good thing for OSF,” he said.

Another positive development, Manson told community leaders, could be the return of earmarks. Lawmakers from both parties are contemplating a return to the practice of using earmarks in federal spending bills. Eliminated previously as contributing to wasteful government spending (think bridge to nowhere), Manson says earmarks might be resurrected so lawmakers who won’t have legislative achievements to tout, can at least boast about federal dollars their returning to their districts.

The "Healthy Workplace" series is just one of the many ways that OSF Saint Anthony’s partners with and engages the communities that we serve.

OSF Saint Anthony’s Health Center President, Ajay Pathak, said, “The purpose of our quarterly series is to give our community a forum and opportunity to learn about more about healthcare, our services, and the care that we provide impacting them as residents and employers here in the RiverBend"

Pathak added, "The topic offered Chris’ insights into the rapidly changing legislative and regulatory environment, and how health care for our community is impacted. Having meaningful dialogue and collaborating together as a community, allows us to collectively make the RiverBend a great place to live and work while making it stronger for the future.”