The Obama administration is considering slashing support for Massachusetts hospitals, members of the state Congressional delegation said Monday, offering a window into secret negotiations that could affect the state’s groundbreaking health care reform efforts and some of its major employers.
In a letter sent to Kathleen Sebelius, the president’s top health and human services adviser, and Chilmark seasonal resident Donald Berwick, who runs the federal Medicare and Medicaid programs, Senators John Kerry and Scott Brown and the 10 members of the Massachusetts U.S. House delegation warned that a change in support proposed by the Obama administration “could significantly threaten payments to Massachusetts health care providers providing care for the most vulnerable populations.”
“These provisions … are crucial to the Massachusetts health reform framework and provide critical and primary funding for the safety net hospitals that care for a growing proportion of Medicaid patients,” the delegation wrote.
The administrations of Gov. Deval Patrick and President Obama have been locked for months in closely guarded negotiations on a three-year pact, known as a Medicaid waiver, to determine the level of federal support for Massachusetts’s multi-billion-dollar Medicaid programs. A previous deal expired in July and the state has obtained one-month extensions while negotiations continue on a three-year waiver renewal.
The letter from the Bay State delegation comes as the Obama administration is grappling with the prospect of making deep cuts to the federal budget, potentially in the trillions of dollars over the next decade. In addition, many of the key provisions of a federal health care reform effort modeled on Massachusetts’s system are slated to take effect in 2014 but have encountered stiff political resistance and court challenges since the president signed it last year.
In their letter, the Congressmen made three specific requests of the Obama administration:
— Offer $4.6 billion to level-fund Massachusetts’s “safety net care pool,” which covers services for the low-income uninsured;
— Support annual payments to certain safety-net hospitals that have struggled due to the economic downturn and an influx of patients associated with changes to the state health care system in 2006;
— Preserve the way “public service hospitals” — hospitals that serve disproportionately low-income and minority residents — receive payments.
“These provisions under the Waiver are crucial to the Massachusetts health reform framework and provide critical and primary funding for the safety net hospitals that care for a growing proportion of Medicaid patients,” according to the letter.
Backers of Massachusetts’s 2006 health reform law have argued since its inception that the number of residents accessing the “safety net care pool” would decrease as residents complied with a mandate to obtain health insurance.
Patrick administration officials have previously highlighted reductions in claims as proof that the health care reform was steering people away from uncompensated care and into an insurance pool.