For 17 years I was President and CEO of a safety net hospital. TrumpCare will “disinsure” twenty million+ people and devastate the hospitals we all depend on.

August 23, 2017

A little background….

I was appointed President and CEO of Jersey City Medical Center (JCMC) in 1989, one year after JCMC had been converted to not-for-profit governance after a long and colorful history as a public hospital (including bankruptcy protection from 1982 to 1985). JCMC was and still is Hudson County’s (500,000+ residents) regional referral center “safety-net” hospital.

“As defined by the Institute of Medicine, the health care safety net comprises hospitals and other providers that organize and deliver a significant level of health care and other health-related services to patients with no insurance or with Medicaid. Often referred to as providers of last resort, safety-net hospitals (SNHs) have historically assumed a major role in the provision of comprehensive services to medically and socially vulnerable populations.” (A)

When I started New Jersey Hospitals were reimbursed through an all-payor state rate-setting system for Medicare, Medicaid, and commercial insurance, which assured hospital financial stability if managed effectively.
This was coupled with a robust Certificate of Need (CN) process which rationed approval of certain tertiary care services to assure access to them throughout the state, rather than based on a hospital’s fiscal situation, since approved CNs garnered additional reimbursement in reimbursement rates.

Already the sole designated paramedic provider for the County, together rate-setting and CN allowed JCMC: to apply for and be designated as a Regional Perinatal Center (1992), Level Two Trauma Center ((1994), and Medical Coordination Center for Emergency Preparedness (2003); and build a total replacement hospital on a new site (CN approved in 1986, hospital opened in 2004) where an Open Heart Surgery CN (approved in 1999) was started. JCMC became a state approved Children’s Hospital in 2000. Along the way JCMC became LibertyHealth adding two community hospitals, Greenville and Meadowlands (which in 1996 opened a CN designated inpatient rehabilitation unit). In 1997 JCMC became a major teaching affiliate of Mount Sinai School of Medicine (now Icahn School of Medicine at Mount Sinai).

All as a safety-net hospital.

Why am I writing all this?

“Hospitals that primarily serve low-income patients could collectively lose $40 billion in funding over the next decade if the Affordable Care Act is repealed and not replaced by something comparable, according to a new analysis by America’s Essential Hospitals.
That amount represents lost coverage and cuts to Medicaid and Medicare disproportionate share hospital (DSH) funding from 2018 through 2026. The ACA called for those cuts because hospitals would have theoretically needed that funding less as more people gained coverage on the marketplaces and through Medicaid expansion.” (B)

“People with health insurance tend to think of safety-net hospitals the way airline travelers think of the bus: as a cheaper service they would use only if they had to. But without these essential hospitals — which specialize in the care of our country’s most medically and financially vulnerable, particularly the uninsured — our entire health care system would be in danger.” …
For uninsured patients, lifesaving surgeries and treatments, along with a limited recovery period, are often covered through Emergency Medicaid funds. But patients who don’t fit neatly into our medical system for reasons of health or finances or their social situation — the “medical misfits” that any one of us can become under the wrong circumstances — need far more long-term support. This is often where safety-net hospitals step in. “(C)

“Despite promises to the contrary, it will leave millions of people without health coverage, and others with only bare bones plans that will be insufficient to properly address their needs. As the nation’s medical schools and teaching hospitals see every day, people without sufficient coverage often delay getting the care they need. This can turn a manageable condition into a life-threatening and expensive emergency.” (D)

“In short, Democrats are focused on trying to maximize the number of people who have decent health insurance, and are willing to accept whatever tax increases and arrangements with health insurers and other private interests are needed to make that happen. They seek the broadest possible availability of health care, whatever the cost and political trade-offs it takes to achieve it.
Republicans are focused on trying to minimize taxes, especially on investment income, and keeping federal subsidies for health care to a minimum. They are willing to accept the wrenching consequences that attaining those goals might have for Americans’ insurance coverage, betting that lower taxes and smaller government will fuel a more vibrant economy.” (E)

(A) https://www.hcup-us.ahrq.gov/reports/statbriefs/sb213-Safety-Net-Hospitals-2014.pdf
(B) http://www.modernhealthcare.com/article/20170209/NEWS/170209902
(C) https://www.nytimes.com/2017/05/26/opinion/sunday/safety-net-hospitals-health-care.html
(D) http://www.beckershospitalreview.com/hospital-management-administration/9-organizations-react-to-senate-gop-healthcare-bill.html
(E) https://www.nytimes.com/2017/06/23/upshot/the-health-debate-shows-what-both-parties-care-about-most.html?smprod=nytcore-ipad&smid=nytcore-ipad-share