If there is one thing I have learned most certainly in my career working to raise quality and lower cost of health care, it is that people don’t stop getting sick or injured just because they don’t have insurance. For both rural hospitals and Level 1 Trauma centers this poses particularly challenging consequences. They are left with the bills of the uninsured and underinsured. This has caused a real crisis for rural and safety net hospitals. I joined my fellow citizens in breathing a collective sigh of relief with every failed repeal effort that would drive the percentage of uninsured up.
So now looms another quiet threat to these hospitals and our neediest citizens. The Medicaid disproportionate share hospital (DSH) program provides crucial support to hospitals that treat patients whose care is not fully covered by third-parties like Medicaid, and it is essential to keeping hospitals that treat low-income patients open and running. Congress failed to act to renew the DSH program before October 1 allowing massive cuts. Missouri will be hit particularly hard, facing a devastating $2.2 billion in cuts through 2025 after having already passed on nearly $2 billion per year in Medicaid funds for working low-income families. For Missouri, it represents a double hit.
Simply put, our state’s hospitals cannot sustain such drastic cuts. Here in Missouri, where Medicaid has not been expanded to cover low-income working families, a large part of our population remains uninsured. If the DSH program is cut, our hospitals would be forced to absorb the costs of treating low-income patients whom we are bound by law and ethics to treat. Though Missouri hospitals are operating more efficiently than ever before, they are not in a position to take on such costs. Hospitals will be forced to either cut services, raise rates, or both, resulting in higher premiums, job losses, and, in some cases, even closure.
If you don’t want to take my word for it, listen to hospitals themselves. The Missouri Hospital Association notes that “the absence of Medicaid expansion has left hundreds of thousands of otherwise eligible Missourians within the ranks of the uninsured. … Without a smart DSH policy, the harm to Missouri and the other 18 non expansion states through Medicaid DSH allocation cuts would be pronounced.”
Access to quality, affordable health care is vital to the prosperity of communities throughout Missouri. When individuals are healthy and hospitals are thriving, the entire community flourishes. But hospitals in Missouri can only afford to provide this much-needed care with support from programs like DSH.
The Children’s Health Insurance Program (CHIP) was also allowed to lapse on October 1. Nearly 90,000 Missouri children receive their health care through the bipartisan Medicaid/CHIP program. Many employers do not extend coverage for children through their plans, leaving many children of working people without any other option for access to health care.
The DSH and CHIP programs are essential to providing health care to the most vulnerable of our fellow citizens and must remain fully funded without any lapses. It is imperative that Congress extend this program rather than cutting it so patients can receive quality care and hospitals can continue providing much-needed services to citizens across Missouri.
Our health care system is complicated and the Affordable Care Act can be improved, no doubt. But now is a time for our members of Congress to push aside the notion of partisan repeal, as seen in the Graham Cassidy Heller bill, that would completely disrupt the health care system and instead work to stabilize our health care system for Missourians. This includes delaying DSH cuts to hospitals and CHIP, which have enjoyed strong bipartisan support in the past, in order to provide critical funding during this time of uncertainty. Now is the time for our elected leaders in Washington to strengthen and stabilize our health care system, not sabotage it.
Judy Baker is a professor of Health Policy at Washington University. She is a former CEO of large clinic systems, former regional director for HHS, and former state representative.