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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Medicaid changes could risk our children’s health
Medicaid changes proposed in the American Health Care Act (AHCA) as passed by the US House would seriously undermine the commitment to protect our children’s health. If the current legislation passes without significant changes to the Medicaid provisions, we risk the health of an entire generation. AHCA requires $834 billion in overall cuts to Medicaid which includes medical care for more than 30 million children nationwide, including 300,000 children in Iowa. (Des Moines Register)

Mental health leader once backed Medicaid privatization, now says it’s forcing staff cuts
The leader of a large Iowa mental health agency, who once defended the state’s shift to private Medicaid management, now says the new system is forcing his company to cut all of its workers’ pay and lay off about 25 of them. Optimae LifeServices President Bill Dodds said the agency has faced serious payment problems under managed care and warned that cuts in Medicaid payments to agencies like Optimae mean some Iowans with serious mental illness, including convicted sex offenders, aren’t being monitored as closely as they used to be. (Des Moines Register)

Let Iowans buy into Medicaid as alternative to private insurance, Democrats say
Iowans who have trouble finding affordable health insurance on their own should be allowed to buy into the state’s Medicaid program, Representative John Forbes (D-Urbandale) and Senator Matt McCoy (D-Des Moines) proposed Wednesday. The idea was offered as an alternative to Iowa’s faltering market for individual health insurance. Under their plan, Iowans with moderate incomes could use Obamacare subsidies to help pay premiums for Medicaid as an alternative to private coverage. (Des Moines Register)

National News

Senate GOP brings Obamacare repeal bill out of the shadows
Senate Republican leaders unveiled their long-secret plan to repeal Obamacare today, giving GOP senators and the public the first glimpse at a bill that would rewrite the nation’s health care system. The bill is expected to repeal Obamacare’s mandates and Medicaid expansion and impose significant cuts to the long-term Medicaid program. Majority Leader Mitch McConnell is pushing for a vote as early as next Thursday, ahead of Congress’ July 4 recess. (Politico)

Republicans’ proposed Medicaid cuts would hit rural patients hard
For the hundreds of rural hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher. Since 2010, at least 79 rural hospitals have closed across the country and nearly 700 more are at risk of closing. And a rural hospital closure goes beyond people losing health care. Jobs, property values and even schools can suffer. These hospitals serve a largely older, poorer and sicker population, making them particularly vulnerable to changes made to Medicaid funding. (NPR)

How the GOP could go nuclear on Obamacare repeal
Senate Majority Leader Mitch McConnell has promised that senators will get unlimited opportunity for amendments in any health care floor fight next week. Liberal activists are urging Democrats to filibuster the bill by attacking it with amendments. But Democratic senators are floating the prospect that McConnell will move to cut off the vote-a-rama if he feels Democrats are putting up votes on amendments purely as a delay tactic — a maneuver that would effectively be tantamount to a legislative nuclear option. (Politico)

New Jersey seeks to regulate hospital protocols for sepsis
New Jersey could become one of a handful of states to require hospitals to follow strict protocols for addressing sepsis. Most Garden State hospitals are already well on their way to meeting the proposal. Dozens of facilities have been working together for several years, with help from the New Jersey Hospital Association, to improve sepsis outcomes by sharing data, treatment protocols and lessons learned. The collaboration has driven down the sepsis mortality rate by 13 percent among participating hospitals. (New Jersey Spotlight)

Police presence could increase on Indiana hospital campuses
Hospitals in Indiana could be beefing up security if they take advantage of a new state law which allows any hospital that treats inpatients to establish a police department on campus. Julie Halbig, vice president of legislative relations at the Indiana Hospital Association, said the bill makes it possible for hospitals to have their own police departments which is especially important in an emergency room setting where sometimes people are in the middle of dangerous situations. (Greensburg Daily News)

Featuring hospital and health care headlines from the media and the Web.

Iowa News

Reynolds wants to talk tax reform, health care with Trump during Cedar Rapids visit
Governor Kim Reynolds said she plans to discuss Iowa’s ailing health insurance exchange with President Donald Trump when he visits Cedar Rapids today. “Of course I’m going to continue to talk about encouraging the White House to work with us on our stopgap measure for insurance coverage so that we have an option for 72,000 Iowans to ensure that they have some type of coverage beginning on July 1 of 2018,” she told reporters at her weekly press conference. (Des Moines Register)

We’d be burying our newborn girl if not for the ‘Count the Kicks’ app, Iowa mom says
The “Count the Kicks” app on Emily Eekhoff’s phone is no game — it’s a lifesaver. The app helps women keep track of how active their babies are in the last three months of pregnancy. A sudden lack of activity can indicate dangerous complications, which happened in Eekhoff’s case. The “Count the Kicks” program was created by five Iowa women who suffered stillbirths and encourages women in the third trimester of pregnancy to measure how long it takes them to feel 10 kicks. (Des Moines Register)

$100K gift boosts hospital OB unit project
Dr. Gerald H. Goettsch was a prolific obstetrician (OB) in the Quad Cities and delivered babies at the former Osteopathic Hospital, as well as the old Mercy and St. Luke’s hospitals that since merged to become Genesis Health System. Her husband’s work inspired Roletta Goettsch to provide a $100,000 gift to Marengo Memorial Hospital, where their son, Barry, is CEO. And it was only appropriate that the money will be used for the labor and delivery unit at the hospital, to be completed in 2018. (Iowa City Press-Citizen)

National News

After weeks of secrecy, US Senate to unveil health care bill
US Senate Republicans plan to unveil the text of their draft health care bill on Thursday as senators struggle over issues such as the future of the Medicaid program for the poor and bringing down insurance costs. Republicans in the chamber have been working for weeks behind closed doors on legislation aimed at repealing and replacing major portions of the Affordable Care Act. The effort has been plagued from the start by tensions between moderates and conservatives. (Reuters)

Hospital group urges changes to GOP health care bill
The American Hospital Association (AHA) on Monday urged Republican senators to make sure hospitals are reimbursed if the number of uninsured patients grows following the passage of a health care bill that would repeal and replace portions of Obamacare. “If coverage is not maintained at the current level, those resources need to be returned to hospitals and health systems in order to provide services to the additional millions of Americans who will become uninsured,” AHA wrote in a letter. (Washington Examiner)

Democrats warn: Obamacare repeal will hurt rural hospitals
Constraining the growth of Medicaid spending and reducing federal support for expanded coverage will disproportionately hurt rural communities, according to a report released Wednesday by the Democrats on the Joint Economic Committee and US Senate Special Committee on Aging. Rural residents are less likely to have commercial insurance and more likely to be low-income than people who live in metropolitan areas, and rural hospitals are particularly vulnerable to cutbacks in the government insurance for the poor and disabled. (Modern Healthcare)

GOP Medicaid cuts would hit states fighting opioid epidemic
The Republican drive to roll back Obamacare is on a collision course with a national opioid epidemic. Medicaid cuts resulting from the GOP legislation would hit hard in states deeply affected by the addiction crisis, according to state data and concerned lawmakers in both parties. The bill would phase out expanded Medicaid, which allows states to provide federally backed insurance to low-income adults previously not eligible – many people who are dealing with opioid addiction (Associated Press/KWWL)

Building blocks: Block grants, per capita caps and Medicaid reform
Republican Medicaid reform proposals have thus far focused on converting federal funding from the current approach of proportional federal and state financing to either block grants or per capita caps. While these funding approaches may sound relatively straightforward, understanding the implications of such changes requires consideration of several factors. A Milliman report breaks down the detailed considerations into two primary categories: initial benchmark development and annual growth rates. (Milliman)

Featuring hospital and health care headlines from the media and the Web.

Iowa News

Iowa Medicaid insurers see financial losses for fourth consecutive quarter
The three private insurers managing Iowa’s Medicaid program again saw millions of dollars in financial losses during the first quarter of 2017, according to a new report out Monday. This is the fourth consecutive quarter in which the insurers reported a negative profit margin. During their first year of operation in Iowa, all three insurers reported losses in excess of $100 million, with AmeriHealth suffering the greatest loss at nearly $300 million. (Cedar Rapids Gazette)

Medica intends to stay in Iowa’s health-insurance market, at higher price
The last carrier standing in Iowa’s individual health-insurance market said Monday that it intends to keep selling such policies here next year, but it would need to charge much higher premiums than it’s collecting now. Even after Monday’s announcement, Medica still could pull out of the Iowa market, as many experts feared. The relatively small, Minnesota-based carrier told Iowa regulators Monday that in order to stay in the market, they would need to increase premiums by an average of 43.5 percent. (Des Moines Register)

Rural Iowa hospitals will face brunt of reduced Medicaid reimbursements
The Iowa Council on Human Services recently approved up to $31 million in cuts to Medicaid providers and comes at the same time that Republicans in Congress are attempting to reduce federal outlays for Medicaid. This will reduce the number of Iowans covered by Medicaid and lower reimbursement for Medicaid providers. The brunt of this will fall disproportionately on rural hospitals, which have a higher proportion of Medicaid patients and some rural hospitals in Iowa may be forced to close. (Des Moines Register)

Patients receive super surprise at Blank Children’s Hospital
Patients at Blank Children’s Hospital got a surprise visit Friday from several superheroes. Four window washers dressed as superheroes flew down the side of the hospital to say “Hi” to the kids in the playroom. The window washers came from Larry’s Window Cleaning Service. The kids got to meet Batman, Superman, Spiderman and Captain America. This is the third year in a row Larry’s Window Cleaning service has partnered with Blank Children’s Hospital for the special event. (KCCI)

National News

Hospital group warns of serious harm from Medicaid cuts
The American Hospital Association (AHA) warned Senate Republicans Monday against including large cuts to Medicaid. “Medicaid serves our most vulnerable populations, including Americans with chronic conditions such as cancer, the elderly and disabled individuals in need of long-term services and support,” AHA wrote in a letter Monday. AHA suggested leaders allow states to use waivers to “improve care and program sustainability” rather than transitioning to a per capita cap or block grant form of funding. (The Hill)

Senate GOP considers deeper Medicaid cuts than House bill
A leading option in the Senate’s Obamacare repeal-and-replace debate is to make even deeper cuts to Medicaid spending than the bill passed by the House. The proposal would start out the growth rate for a new cap on Medicaid spending at the same levels as the House bill, but then drop to a lower growth rate that would cut spending more starting in 2025. A separate Medicaid issue — how quickly to phase out the funding for the expansion of the program — remains up in the air. (The Hill)

ER visits up, uninsured visits down in Medicaid expansion states
A new Annals of Emergency Medicine report found that Medicaid expansion under the Affordable Care Act led to 2.5 more emergency room (ER) visits per 1,000 people after 2014. Uninsured visits to the ER decreased by 5.3 percent. Emergency medicine does cost more, but with more emergency patients insured, hospitals aren’t on the hook for as much uncompensated care. Advocates for Medicaid expansion could trumpet this latest report as reason for not rolling back Medicaid expansion. (Healthcare Dive)

Senate GOP prepares for Obamacare repeal vote next week
Senate Republicans are preparing to vote on Obamacare repeal next week, provided this week’s work goes smoothly, according to multiple sources familiar with the negotiations. Senators are expected to see bill text as soon as the end of this week, those sources said. The timeline could change based on the response from individual senators toward the proposal at party meetings, but Republicans are increasingly optimistic they can hold a vote next week if this week’s lunch talks go well. (Politico)

How does health spending in the US compare to other countries?
A new analysis looks at 2015 health data from the Organization for Economic Cooperation and Development (OECD) Health Statistics database. It looks at how spending on health care in the US compares to other OECD countries that are similarly large and wealthy. Wealthy countries like the US tend to spend more per person on health care and related expenses than lower income countries. However, the US spends more per person on health than comparable countries. (Peterson-Kaiser Health System Tracker)

Featuring hospital and health care headlines from the media and the Web.

Iowa News

New budget cuts surprise groups providing services to Iowans with disabilities, diseases
Health care providers and not-for-profits across the state are scrambling to carry out even tighter budgets come July 1 after the Iowa Department of Public Health (DPH) notified them last week that it is making an additional $1.3 million in cuts. They come after DPH’s general fund budget was slashed by more than 13 percent during the 2017 legislative session and come as a shock to the organizations, who provide what they believe are necessary services for disabled and sick Iowans. (Cedar Rapids Gazette)

New UnityPoint Health Fair focused on parenting
Children gave their teddy bears check-ups, moms learned about healthy breastfeeding and dads checked car seats for safety Saturday at the UnityPoint Clinic in Muscatine. The hospital held its first ever Growing Up With UnityPoint Health Fair over the weekend, to inform new and expectant parents about the resources available to them in Muscatine. Obstetrician Care Coordinator Abbie Derksen said having children watch their teddy bears or baby dolls receive a check-up can ease fears about going to the doctor. (Muscatine Journal)

Therapy dogs help patients heal at Mercy Medical Center
Several studies have shown that pets can unleash a certain type of healing power. That’s why Mercy Medical Center is using therapy dogs to help bring comfort and happiness to a number of patients. These dogs have to get certified to be therapy dogs and they even wear a special badge to show that they are volunteers. When the hospital’s doors open patients usually expect to see doctors or nurses walk inside. But on Wednesdays, patients are greeted by a very special four-legged volunteer. (KCRG)

National News

Rural hospital crisis in Tennessee in need of a cure
Of the nine hospital closures in Tennessee since 2013, seven are in rural areas. Nearly 60 other hospitals across the state are financially strapped and are at risk of closing. “These hospitals are lifelines in their communities. They serve as hubs for affordable quality health care, and more often than not are the largest employers in the area,” said Craig Becker, president and CEO of the Tennessee Hospital Association. (Knoxville News Sentinel)

Minnesota Hospitals fear health plan changes will add up to big losses
Minnesota hospital executives expect big hits to bottom lines if Congress approves President Donald Trump’s proposed budget or the US Senate passes a health care reform bill like one approved by the House. The Minnesota Hospital Association spokeswoman Wendy Burt said 38 hospitals in Minnesota already operate at a loss. “It is more than fair to say that uncompensated care will go up if the Affordable Care Act is repealed or Medicaid is cut as significantly,” said Burt. (Minneapolis Star Tribune)

Nevada governor vetoes Medicaid-for-all bill
There will be no Medicaid-for-all option in Nevada. Governor Brian Sandoval waited until the last day he could — Friday — to veto a measure that would have offered a state-sponsored health insurance option to all residents regardless of income. If he hadn’t signed it or vetoed it by midnight, it would have become law. Had the Republican governor signed it, however, Nevada would have become the first state to attempt a Medicaid-for-all approach to health insurance. (Los Angeles Times)

Health care reform bill is ‘problematic,’ both GOP and Democratic governors say
A bipartisan group of governors are criticizing the Republican health care bill currently being crafted in Congress, arguing the legislation fails to protect the vulnerable and shifts the financial burden of coverage to the states. In a pointed letter to Senate Majority Leader Mitch McConnell and Minority Leader Chuck Schumer, the governors called on senators to engage with them in the health care reform debate— arguing the current draft of the GOP’s health care bill was insufficient to ensure adequate coverage and affordability. (CNBC)

Obamacare repeal and the Senate: Where it stands
It’s a key two weeks for Senate Republicans, who are edging closer to a vote as soon as the end of this month on legislation to repeal and replace Obamacare. Lawmakers have yet to see text of a bill and are deeply divided over key questions, such as how quickly to phase out Medicaid expansion. Senate Majority Leader Mitch McConnell (R-Kentucky) has suggested he wants to hold a vote before the July 4 recess to prevent healthcare from eating up more of the Senate’s time. (The Hill)

Experts at the Congressional Budget Office say the American Health Care Act (AHCA) would result in 23 million people — including children, the disabled and those with pre-existing conditions — losing coverage by 2026. The analysis also shows the bill would disproportionately affect older Americans, ages 50 to 64, and those covered by Medicaid. Obviously, this includes thousands of Iowans.

Iowa hospitals are particularly concerned about the enormously negative impact to Medicaid from AHCA, which includes $834 billion in cuts to the program. Most distressing is the bill’s intent to roll back Medicaid expansion, which has benefited some 150,000 Iowans who now have coverage and much improved access to consistent, coordinated health care.

AHCA “per-capita caps” placed on Medicaid federal funding would shift greater cost and risk to states. In turn, states would likely respond by tightening Medicaid eligibility requirements and reducing enrollee benefits and provider payments. Meanwhile, states would have to fully cover any future unexpected Medicaid costs without federal help, radically changing a 50-year partnership between state and federal government that has responded to unexpected health crises, including hurricanes and floods as well as economic downturns. Again, tightening eligibility and cutting payments are likely responses.

Here is what else we know:

AHCA would be especially harmful to rural Americans. Nearly 1.7 million rural Americans have gained coverage through Medicaid expansion. In Iowa and at least seven other expansion states, more than one-third of expansion enrollees live in rural areas. Rural hospitals depend on Medicaid for 10-20 percent of their revenue and, because of their smaller patient volume, do not have other revenue sources to make up for what would be lost if AHCA is implemented. Most of the 78 rural hospitals that have closed since 2010 are in states that did not expand Medicaid.

AHCA would cost Iowa jobs: A new study estimates the AHCA would cause serious economic damage across the nation, including the loss of some 9,200 jobs in Iowa. The AHCA would raise employment and economic activity at first, but lower them in the long run. It initially raises the federal deficit when taxes are repealed, leading to 864,000 more jobs in 2018. In later years, reductions in support for health insurance would cause negative economic effects. By 2026, 924,000 jobs would be lost, gross state products would be $93 billion lower and business output would be $148 billion less.

AHCA threatens special education programs. School districts, including those in Iowa, rely on Medicaid to provide costly services to millions of students with disabilities across the country. AHCA-imposed “per-capita caps” on Medicaid would effectively transfer the burden of health care to state budgets, likely resulting in higher taxes, eligibility cuts or curtailed services for children or others who depend on Medicaid. Many such education services are mandated under federal law but even now struggle from chronic underfunding.

Medicaid is crucial to fighting the opioid crisis. More than two million Americans are fighting a prescription opioid addiction and another 591,000 have a heroin addiction. Opioid overdoses killed 61 Iowans in 2015, more than double the number from 2005. Medicaid and the Children’s Health Insurance Program cover about one in three of these patients, but their coverage could be lost under AHCA. Coverage of expensive medications, such as methadone and naltrexone, is included in most states’ Medicaid programs and has been effective in reversing addiction, especially when combined with counseling. Most states have also increased Medicaid enrollees’ access to naloxone, which can save the life of someone who has overdosed on opioids.

AHCA could also affect people insured through their work. The Affordable Care Act (ACA), which AHCA seeks to replace, protects essential health benefits (EHBs), a baseline of common procedures and items including emergency room visits, prenatal care, mental-health care and some prescriptions. Because of ACA, employer plans cannot place lifetime limits on the amount plans pay out on EHBs and requires plans to limit out-of-pocket costs an employee must pay annually. The AHCA would allow a business to drop these employee protections by choosing regulations by way of a state-granted waiver.

Americans generally agree that AHCA is a bad idea. The most recent Kaiser Health Tracking Poll finds more Americans have an unfavorable view of the AHCA than a favorable one (55 percent vs. 31 percent, respectively). This poll also showed a considerable “enthusiasm gap” with a far larger share saying that they have a “very unfavorable” view (40 percent) than saying they have a “very favorable” view (12 percent). An earlier Quinnipiac poll showed similar results, with 21 percent of voters supporting AHCA while 56 percent opposed it.

Meanwhile, public approval of ACA has increased to a majority since the election, according to Gallup, from 42 percent approving and 53 percent disapproving in November 2016 to 55 percent approving and 41 percent disapproving in early April 2017.