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.

Debunking the BCRA Disinformation

I have worked in the healthcare field for 27 years and the amount of disinformation swirling around the U.S. Senate’s “Better Care Reconciliation Act” is staggering. Let me address the falsehoods:

  • No, the bill does not provide sufficient protections for those with pre-existing health conditions. It’s true that one part of the bill prohibits charging people more for pre-existing conditions, but another section allows governors to apply for waivers for their states to deny coverage for certain conditions or charge more. This is the proverbial Schrödinger’s Cat of the BCRA, a paradox in which it is true because it is prohibited, while it is allowable in another section of the bill.
  • House Speaker Paul Ryan (no relation) claims there’s a good reason that fewer people will be covered under the Senate bill: because they will elect not to obtain coverage. This is false. The Congressional Budget Office’s analysis of the bill shows that the majority of the people who will lose healthcare coverage are Medicaid recipients. These are our seniors, children and people with disabilities who rely on Medicaid for care and who could be unceremoniously removed from Medicaid, or see their benefits reduced, under deep cuts to the program.
  • “Obamacare is imploding.” Not true, as stated explicitly by the CBO. The Medicaid expansion under the Affordable Care Act is working well, and this is the largest segment of people insured under the ACA. Those insured under the Marketplace are a smaller number, and it’s true that the Marketplace or exchanges could use reforms. Every state has insurance options available under the Marketplace, although it’s true that there are some isolated counties where no plans are available. The good news is that many states, including New Jersey, have recently had insurance companies expanding into the Marketplace. That gives consumers more options to purchase insurance, but I think everyone agrees that there is more we can do to drive down premiums and deductibles.
  • One of the ugliest comments I’ve heard about Medicaid is that its recipients should “just get jobs.” This is callous and uninformed. First, nearly 60 percent of New Jersey’s nursing home residents are on Medicaid. Medicaid also covers one in three children in our state. It’s hard to get a job when you’re in a nursing home bed or are a schoolkid. In addition, reports show that eight in 10 Medicaid recipients live in a household where someone works, but that person is not lucky enough to have a job that provides health insurance.
  • “CBO data is inaccurate.” It’s easy to blame the messenger, but the CBO is a nonpartisan entity that is highly respected and puts out very credible information. The CBO score on the BCRA clearly impacted the Senate’s decision not to vote this week. Senators saw the report of 22 million Americans losing insurance as really important news, critical to their decision making.
  • The biggest misnomer of all? Its name, the “Better Care Reconciliation Act. If cutting health insurance for 22 million people is “better care,” then I have a bridge to sell you.
Written by Betsy Ryan at 00:00

AHCA: Say No to This Disastrous Health Law

There are two sides to every issue, but I can’t accept misinformation when it comes to our health. I just saw a TV ad supporting the American Health Care Act which is irresponsible and callous in its twisting of the truth.

Rather than yelling at the TV, I’m sitting at my keyboard to counter those claims with information that has been substantiated by the nonpartisan Congressional Budget Office, which is tasked with reviewing all pending legislation for its impact on the American people. Twenty-three million people will lose their health insurance under this law, a fact that is conveniently missing from the TV ad. But among its other claims, the ad declares that the AHCA would:

  • “lower costs.” (Not true, especially if you happen to be between the ages of 50 and 64 and don’t earn much. That group – which most needs good coverage but can least afford it – would face the largest insurance price hikes under the AHCA.)
  • Provide “better coverage.” (Not true. One of the ways the AHCA aims to reduce insurance premiums is by stripping away minimum required benefits such as preventive care, hospitalization and mental health and substance use services. Of course the premiums may seem low – because they offer very little coverage. In fact, the CBO says some of the plans would be so bare bones that they wouldn’t even qualify as insurance.)
  • Provide “protections for pre-existing conditions.” (Not true. The AHCA allows states to remove the pre-existing condition protections for people with cancer, diabetes, asthma and other illnesses and replace them with high-risk pools for those individuals. The problem is, the AHCA doesn’t provide enough funding for the high-risk pools, and experts including the CBO say those living with pre-existing conditions “would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

Don’t take my word for it – or the CBO’s for that matter. All you need to do is look at the groups that oppose the AHCA such as AARP, American Cancer Society, Families USA, AFL-CIO, the American Medical Association, the American Hospital Association, the National Disability Rights Network, National Education Association, Children’s Defense Fund and countless others. Even America’s Health Insurance Plans – the national organization that represents insurance companies – has criticized the AHCA. These groups represent senior citizens, families, workers, consumers, healthcare professionals and patients. I trust them – not a hired TV spokesperson.

For fact-based information on the AHCA and its impact right here in New Jersey, visit our website to learn more about the 800,000 N.J. residents who could lose health insurance, the 1.8 million Medicaid beneficiaries whose care is threatened and the $4.4 billion in federal funds that New Jersey would lose. I truly believe the more you know about the AHCA, the louder you’ll say no to the AHCA. #kNOwAHCA

Written by Betsy Ryan at 00:00

‘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.

Written by Betsy Ryan at 00:00

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.

Written by Betsy Ryan at 00:00

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Hospital Charges: 3 Things New Jerseyans Need to Know

The federal Medicare program generated headlines this week when it released a big spreadsheet listing hospital charges for a number of different procedures. The numbers were compelling by the sheer fact that they varied so widely, across the nation and even within states. Seems like everyone from news anchors to Princeton economist Uwe Reinhardt debated whether this information on charges carries much relevancy. Virtually everyone acknowledged that what hospitals list as charges and what they actually get paid from Medicare, Medicaid and commercial insurance companies are two very different sets of numbers. But today, I want to cut through the clutter and just share three very important things that New Jersey healthcare consumers need to know about hospital charges and medical bills.

  1. The overwhelming majority of you will never, ever see a bill that includes hospital charges. Only about 4.5 percent of N.J. hospital patients could potentially be billed at charges. These are the individuals who earn too much to qualify for a subsidized insurance program like Medicaid or NJ FamilyCare and who opt not to purchase insurance on their own.
  2. A 2009 state law caps hospital charges for most uninsured patients. Any individual earning up to $117,750 annually for a family of four would have any hospital charges capped at 115 percent of what Medicare would pay for the same service. And since Medicare only pays N.J. hospitals about 90 percent of their costs, the “charge” to these patients would be just slightly above what it costs hospitals to provide their care.
  3. And to the small group of individuals who may be billed at charges – or even for those insured patients who face major medical bills that their plans do not cover: Contact your hospital and ask about discounts and payment plans. Almost all New Jersey hospitals have a set of compassionate billing guidelines to work with patients who are struggling with medical bills.
Written by Betsy Ryan at 00:00