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July 25, 2014

MHA Today is provided as a service to members of the Missouri Hospital Association. Additional information is available online at MHAnet.


Herb Kuhn, MHA President & CEO

On Tuesday, the long-awaited decision on marketplace subsidies from the D.C. Circuit Court of Appeals was handed down. The court’s 2-1 decision rejected the extension of tax subsidies to individuals in states with a federally-facilitated marketplace. It was bad news — if not the last word — for the 33 states with federally-facilitated marketplaces.

For a couple hours, that was the story. Then, things got weird. Later in the day, the 4th Circuit Court of Appeals — located just south of Washington, D.C., in Richmond, Va. — upheld the same subsidies.

The U.S. Justice Department will appeal the three-judge decision from the D.C. court, and court watchers speculate that the panel, en banc, will likely reverse Tuesday’s decision. One thing is for sure; the matter will continue to be litigated.

If you find the fact that two courts — in a single day and only 100 miles apart — could offer remarkably contradictory opinions, you are not alone. One hundred miles may separate the judges, but their views were worlds apart. And for the average Missourian, that’s perplexing.

News coverage of the D.C. circuit’s opinion — and the 4th circuit’s counter opinion — included comments from enrollees. They found the prospect of losing access to their marketplace policies devastating. For many of these enrollees, their lost coverage would be prohibitively expensive without a subsidy.

Before the marketplace open enrollment began last year, more than 800,000 Missourians were uninsured. However, during the enrollment period, 150,000 citizen — including approximately 127,000 who received a subsidy — signed up for a plan through the marketplace. Although the number of new marketplace enrollees who were previously uninsured is still being assessed, that’s a huge chunk of the state’s uninsured and an important milestone for Missouri.

The path to better health is through a more logical health care system — one that’s rooted in health insurance coverage and primary care, not through the emergency room door. Improving population health is dependent on the same thing. Missouri’s health status ranks 39th in the nation, down from 24th just two decades ago. To make progress, we need the Missourians who received subsidized marketplace coverage to keep it, and we need to add to the number of insured Missourians through the marketplace and through Medicaid reform.

If the D.C. circuit’s initial ruling holds, the consequences for individual health are real, and so are the consequences for providers. Hospital uncompensated costs exceed $1 billion annually. Right now in Missouri, an uninsured person goes to a hospital emergency department every minute of every day, seven days a week, 365 days a year. Moreover, hospitals are helping to pay for the marketplace subsidies through the Affordable Care Act — we can’t afford to have those covered lives disappear back into the ranks of the uninsured.

The D.C. circuit’s decision doesn’t have an immediate effect on coverage. In fact, it may be quite some time before we know whether lawmakers’ “intent” will trump the statutory language that is at the center of the fight. However, very little of the conversation about judicial opinions, legislative intent and the language of the ACA matter to those with a newfound ability to seek care or provide it for their families. Ultimately, they care about the potential loss of their coverage. They find that both confusing and disturbing.

As health care leaders who have been participants in the ups and downs of the ACA rollout, the ongoing litigation may not be confusing. However, the prospect of losing the estimated 127,000 covered lives coved by a marketplace subsidy in Missouri is disturbing.

We need this affirmed or fixed. There’s too much at stake.

Let me know what you are thinking.



Herb B. Kuhn
MHA President and CEO

In This Issue
NQF Studies Sociodemographic Factors In 30-Day Hospital Readmissions
IRS Releases Proposed Rules, Draft Forms On Health Coverage

Advocate Advocate state and federal health policy developments

NQF Studies Sociodemographic Factors In 30-Day Hospital Readmissions
MHA Staff Contact: Andrew Wheeler

This week, the National Quality Forum announced it will conduct a new trial focusing on the impact of sociodemographic factors on 30-day hospital readmissions. The Centers for Medicare & Medicaid Services currently imposes financial penalties for certain hospital readmissions, and health policy advocates have argued that hospitals in poor communities may be unfairly penalized by the policy because of factors beyond their control. NQF plans to investigate the issue by creating a disparities committee to help with the assessment.

Earlier this month, NQF’s Risk Adjustment for Sociodemographic Factors Expert Panel released a final report on sociodemographic status risk adjustments. Steve Lipstein, CEO of BJC HealthCare in St. Louis, served on this panel and discussed the report recommendations in MHA Today last Friday. MHA supports the use of sociodemographic factors on 30-day readmissions.


Regulatory News Regulatory News the latest actions of agencies monitoring health care

IRS Releases Proposed Rules, Draft Forms On Health Coverage
MHA Staff Contact: Andrew Wheeler

The Internal Revenue Service issued temporary and proposed rules on the premium tax credit for health insurance purchased through the health insurance marketplace. The proposed rules provide methodology, clarify how to reconcile tax credits with advance premium payments and address the premium deduction for self-employed individuals. 

The IRS also released drafts of forms to be used when filing taxes for employers and individuals to determine their compliance with the Affordable Care Act.  In addition, the IRS posted draft versions of the more common forms, such as the 1040 and 1040EZ, for the next filing season. Form 1095-A asks for information about the recipient and the coverage household; this will be used as a benchmark for determining the premium tax credits available to members of a household. Form 1095-B requests information about the responsible individual, along with information on employer-sponsored coverage. Form 1095-C includes the employee share of the lowest cost monthly premium for self-only minimum value coverage. The IRS also released forms 8941 relating to credit for small employer health insurance premiums, 8962 for information about the premium tax credit and 8965 for those who have been granted a coverage exemption.


Did You Miss An Issue Of MHA Today?

The following articles were published in this week’s issues of MHA Today and are available online.

July 24, 2014
HHS Announces Consumer Savings Through MLR Provision
MLN Connects Provider eNews Available

July 23, 2014
CMS Announces IPF Support Contractor Change
CMS Deletes Large Sections Of Provider Reimbursement Manual
AHRQ, Joint Commission Launch Long-Term Care e-Learning Module
Report Finds Patients Have A Different View Of Quality

July 22, 2014
Appeals Courts Issue Conflicting Decisions On Subsidies
Report Estimates Cost Of Untreated Mental Illness In Missouri At $2.5 Billion
MHA Posts MEDES Information On Medicaid Eligibilty, Enrollment
MHA Distributes First Quarter 2014 Medicare VBP Analysis
More R.N.s Delay Retirement, Causing A Larger Workforce

July 21, 2014
HIDI HealthStats — Economic and Financial Stresses: Operating Margin
HIDI Releases Updates To Hospital-Specific Readmission Dashboards
HHS Posts Interpretive Guidance Concerning 340B Program
NCSBN Provides Nursys e-Notify Free Of Charge To Nurse Employers

MHA Consider This Consider This ...

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Source: ALS Association

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P.O. Box 60 • Jefferson City, MO 65102
Phone: 573/893-3700 • Fax: 573/893-2809 • MHAnet
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