Betsy Ryan is president and CEO of the New Jersey Hospital Association. Her blog, Healthcare Matters, examines the many issues confronting New Jersey's hospitals and their patients. Readers are encouraged to join the discussion, because healthcare matters - to all of us.

An Open Letter to the N.J. Congressional Delegation: It’s Time to Show Courage on Healthcare

I have been thinking a lot about John F. Kennedy’s book Profiles in Courage, which outlined difficult political decisions made by U.S. senators over our nation’s history. Often the decision was a balance between what was right versus intense political pressure. Our N.J. Congressional Delegation faces a difficult vote this Thursday, when Paul Ryan’s American Health Care Act is up for a vote in the House of Representatives. Here are 10 reasons why I urge every member of our delegation to vote no:
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N.J. Residents Need Coverage in ACA Replacement Plan

Today we’re getting our first close look at House Republicans’ proposal to replace the Affordable Care Act. There’s a lot to pore over, but our first and overriding concern is that access to healthcare through safety net providers does not equal coverage – and coverage is essential to good health, a strong healthcare delivery system and reduced healthcare costs.

President Trump had assured the country that no one would lose coverage under his plan, but this proposal does not provide that guarantee. The proposal to change Medicaid from a federal-state partnership to a program that simply provides per-capita lump sum payments to the states raises serious worries about the future coverage of the 553,474 New Jersey residents who are covered under Medicaid. Medicaid beneficiaries have access to a primary care doctor and preventive care under that coverage. It would be a very harmful step backward if a portion of those New Jersey residents lose coverage and return to the days when they used the hospital emergency room for all of their healthcare. That’s not good for those New Jersey residents, and it’s just not a smart way to deliver healthcare services.

Less planned and preventive care will raise healthcare costs for all. It also raises real worries about the future of hospitals. As more people gained health insurance coverage, the state significantly reduced funding for hospitals that provide charity care for the poor and uninsured. Those cuts totaled $373 million over the last three years, and Gov. Christie has proposed even deeper cuts in the next state budget. Those cuts, coupled with the proposal we see here, could gut funding for our hospitals.

 

 

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‘Do No Harm’: Words to Remember as Congress Debates ACA’s Future

The oath every physician takes is to “Do no harm.” I think it’s an important credo for Congress and the Trump Administration to bear in mind as they wrestle with the future of the Affordable Care Act.

There are countless stories of real people, with real healthcare worries, that have been helped by the ACA. They are the most poignant reasons to preserve a law that has helped people access better healthcare and has protected them from financial devastation if they are hit with a major illness or pre-existing condition.

Truth is, the potential for harm extends far beyond the 22 million Americans and 800,000 New Jersey residents who receive health insurance under the ACA. The impact could be felt in reduced coverage protections for all healthcare consumers, in financial hits that jeopardize healthcare providers that care for us all and in deep federal funding cuts that could punch a hole in our state budget – with potential reverberations for all residents.

Those of us in the healthcare community are watching the current debate over whether to “repeal, replace or repair” the ACA with the hope that Washington does no harm to an industry that is responsible for 17 percent of our nation’s gross domestic product.

The ACA has, quite frankly, changed the way our healthcare system operates. The healthcare community has moved aggressively since the law’s passage in 2010 to implement the component parts by enrolling uninsured individuals into Medicaid or an insurance plan; adopting more preventive health measures to keep people out of the hospital; and investing greatly in improved healthcare quality to prevent hospital readmissions and increase the value of the care we deliver.

Insurance coverage is critical to providing care to people in the right healthcare setting – that is, the setting where people can get the appropriate level of medical services at the lowest cost. It makes no sense to wait until you are very ill to come to an emergency department for care when a visit to a primary care doctor a week prior could have prevented that from happening.

I’m heartened to hear President Trump say that no one will lose coverage under a replacement plan. That’s critical to the people who are now covered under the law, and it’s also critical to the healthcare provider community in New Jersey. Why? There are two reasons.

First, the provider community – hospitals, health systems, nursing homes and others – absorbed $1.8 billion in cuts over a eight-year period to help pay for the ACA. Those cuts were offset because providers were caring for many more people with health insurance. If the coverage under the ACA erodes, our healthcare system could be staggered by a one-two punch: billions of dollars in cuts, plus the loss of payments from insurance companies.

Second, New Jersey law requires all of our hospitals to provide care to all people in all settings, regardless of their ability to pay. We’re proud of this commitment to caring for all of our communities here in the Garden State, but it comes with a steep cost. Prior to the ACA, hospitals provided more than $1 billion annually in charity care services to 1.3 million uninsured New Jerseyans. In exchange, hospitals received partial reimbursement from the state. The state kicked in $650 million for those charity care costs prior to the ACA’s coverage mandate, but that funding stream has now been reduced to $302 million as the number of uninsured diminished.

Gov. Christie made the right decision for our state to expand Medicaid to more individuals, and it has had a real impact. But if the ACA is repealed without an adequate replacement, the number of insured will spike. Hospitals will provide the care needed, but it will require a reinvestment of state dollars into the charity care pool to adequately pay hospitals for that care. If the reinvestment doesn’t occur, many New Jersey hospitals will struggle financially. It’s a simple, but alarming, formula: Fewer patients with insurance + less money to pay for charity care = a fiscal crisis for New Jersey’s healthcare community.

Our “ask” to Congress members is this: As you debate how to recast the ACA – whether a “repair” or a “replacement” – recognize the importance of health insurance for those 800,000 New Jersey residents and the healthcare providers that care for them. And then, remember that age-old oath and do no harm.

Elizabeth “Betsy” Ryan, Esq., is president and CEO of the New Jersey Hospital Association, a not-for-profit healthcare trade organization based in Princeton.

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Consumer Resources Need to be Accurate to be Consumer Friendly

Increased pressure for transparency and lower costs has created a wealth of hospital quality “report cards,” intended for consumers to make well-informed healthcare decisions. But as there are more and more of these ratings systems developed, instead of having a clear idea of quality of care, the waters get muddied. Imagine receiving five or more different report cards in school!

The Centers for Medicare and Medicaid Services (CMS) just released its attempt at a report card – a star rating system for hospitals – for the first time July 28. The system compresses all 64 quality measurements that make up the Hospital Compare database into a one-star through five-star ranking of hospitals around the country. The government’s hope was to provide a clear picture of hospital performance, but we think consumers will walk away from the new system more confused than before.

The New Jersey Hospital Association, its members and members of the New Jersey Congressional delegation were among many voices asking CMS to delay the release of the star ratings system until several issues were clear. We had concerns that the rankings were not adjusted for sociodemographic factors – a major driver of health outcomes – which punishes hospitals in ethnically diverse states like New Jersey. In New Jersey, there are more than 150 different languages spoken by our patients. This report card actually punishes hospitals that treat a large number of low income patients.

We were also concerned that, while the ratings were intended to increase transparency, hospitals were unable to get the data used by CMS to create the rankings. Not being able to replicate the process and double check the numbers used means hospitals have little recourse to dispute a potentially incorrect score. Other issues raised by hospitals and Congressional leaders included lower ratings for hospitals that see a disproportionate share of low-income patients and that train medical students.

Our members are not opposed to transparency. We tried to work with CMS to refine the process and create a useful tool for patients and their families across the state. An informed consumer is good for all parties involved. Unfortunately, the star system was published without many of the stakeholders’ concerns being addressed.

We will continue to work with CMS and other rating organizations to ensure that the high quality of healthcare offered in this state is recognized fairly and accurately.

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Time for Legislation, Not Litigation

In one year since the Morristown Memorial tax court decision was announced on June, 25, 2015, 30 lawsuits representing more than half of the state’s 58 non-profit hospitals have arisen across the state pitting municipalities against their not-for-profit hospitals. While not particularly surprising, this is an unfortunate response. Over the years, hospitals and municipalities have had a strong history of working together as good partners and it is a shame that these mounting lawsuits are eating away and placing stress on these otherwise successful and cooperative working relationships.

The initial response by members of the New Jersey Legislature following the court decision was to introduce a bill to provide consistency and certainty for both hospitals and municipalities. The bill was pocket-vetoed by the Governor, who instead called for a two-year freeze on any property tax liability and a commission to study the 70-year statute that was the basis for the original dispute and offer a solution. Since January, there have been a few bills introduced but no formal action has been taken on any of them.

Instead of endless litigation, what is needed is a thoughtful legislative approach that would create a sound statewide policy allowing hospital contributions to flow to their towns much faster than disjointed, drawn-out legal battles. We urge the Legislature to pass a bill that quells the legal uncertainty for not-for-profit hospitals and ensures a balanced statewide solution.

Make no mistake, hospitals are more than willing to contribute to their towns for the municipal services they use. The hospital community supported the bill in the lame-duck session of the Legislature that would have provided $25 million in hospital financial support to their communities.

Today, hospitals support bill A-3635/S-2329 sponsored by Assemblyman Herb Conaway and Senator Nilsa Cruz-Perez. This bill provides an opportunity for thoughtful discussion while placing a moratorium on the lawsuits that could cost towns and hospitals millions to litigate and years to resolve. Specifically, it would create a “Non-Profit Hospital Property Tax Exemption Study Commission” that would meet over a two-year period to develop and recommend a sound statewide policy approach. We’ve even offered compromise language that would have hospitals contribute a reasonable amount to their municipality while the study commission does its work.

A second bill S-2212/A-3888, introduced by Sen. Bob Singer (R-Ocean), would protect the legality of PILOT agreements – or Payments in Lieu of Taxes – between hospitals and their host municipalities. The hospital community also supports that measure.

The Morristown case that initially spurred this issue was seven years in the making. It’s wise to take some time as presented in bill A-3635/S-2329 to get this right and arrive at a sound solution that will help municipalities and tax payers without threatening the viability of hospitals and the healthcare services they provide to our communities.

With time ticking away, it is inevitable that more municipal lawsuits will be added to the already substantial list. This patchwork of litigation offers no guarantee of consistency or equality for individual municipalities or the hospitals, and perpetuates an ongoing cycle of lawsuits that will take years to resolve and cost millions to litigate.

While supporting new legislation and agreeing to pay their fair share, it is important to note that New Jersey’s non-profit hospitals already contribute significantly to municipalities and the state, as reported by EY (formerly Ernst & Young LLP). These hospitals deliver care 24/7, provide $2.4 billion in community benefit and serve as prime drivers of economic activity within their communities – employing nearly 144,000 people whose wages and tax contributions ripple throughout the economy. Charity care services to the poor and uninsured alone total about $1 billion annually.

This group of not-for-profit hospitals that have been exempt from property taxes in New Jersey since laws were enacted in 1913 have already volunteered in a unified manner many months ago to contribute additional funds to their municipalities to support essential functions and provide local property tax relief. In return, the only thing requested by the hospitals was to preserve their current property tax exemptions and provide them relief from litigation.

So, I return to my call for legislation versus litigation. We support bill A-3635/S-2329 that addresses the needs of municipalities, while providing certainty to our hospitals. We urge action on this legislation and re-affirm that our members are committed to doing their share to support their municipalities, while continuing to serve as good neighbors and answering the needs of their patients.

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