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« Legislative News NACo Expresses Health Care Priorities to Federal Senate Finance Committee
By Rick Thompson
TAC Legislative Staff
In a recent letter to the Federal Senate Finance Committee, the National Association of Counties (NACo) laid out its top priorities for counties as the committee prepares to mark up legislation to reform our nation’s health system. Each of the three listed priorities could assist Texas and its counties in their efforts to provide comprehensive health care in the most efficient manner.
The following include excerpts from the letter and analysis of NACo’s priorities as they apply to Texas counties.
Priority 1
“NACo supports expanding Medicaid to increase coverage for low income Americans without shifting financing costs to county property taxpayers. Reimbursement rates should be enhanced and the federal medical assistance percentage (FMAP) for newly eligible populations should be 100 percent. Any other FMAP increases should be passed through to counties in states that require counties to contribute to the non-federal share.”
In Texas, expanding Medicaid to include coverage for more low income citizens could help ease the intense distress put on all health care providers, including urban and rural hospitals. Ultimately, increasing eligibility would reduce the number of uninsured — Texas leads the nation with more than 6 million — allowing more opportunities for formerly uninsured citizens to seek primary health care. Without insurance, patients often go without preventative care and finally seek medical attention from the most expensive source when their conditions worsen: emergency rooms. Emergency rooms, in many cases, are supported by local property tax dollars.
Federal medical assistance percentages are used by states to determine the amount of federal matching funds allocated annually to certain medical and social service programs such as Medicaid. Increasing the federal share to 100 percent would add more uninsured citizens to these programs at no cost to the state. Priority 2
“NACo opposes mandatory “savings” from the Medicaid disproportionate share hospital (DSH) program. County hospitals will continue to depend on DSH to serve those who will remain uninsured and uninsurable even after reform and to compensate for Medicaid’s low reimbursement rates. Experience shows that local taxpayers will continue to be called upon to make up shortfalls in order to preserve expensive essential services provided by county hospitals.”
State and federal laws mandate that state Medicaid programs make special payments to hospitals that serve a disproportionately large number of Medicaid, low-income, and indigent patients.
Our hospital system relies greatly on DSH for help with a large burden of the uncompensated and indigent care and recent proposals in federal health care overhaul legislation would eliminate some or all DSH funds. According to Texas Health and Human Services System, Texas paid $1.5 billion in disproportionate share hospital funding to three state-owned teaching hospitals, one state chest hospital, 10 state psychiatric hospitals and approximately 165 non-state hospitals. Of this $1.5 billion, more than $960 million came from the federal government. Priority 3
“NACo supports making conviction of a crime, and sentencing to secure detention the trigger for termination of federal health benefits. Coverage for persons in pre-trial custody and presumed innocent should not be withdrawn without due process. The provisions of HR 2209, the Restoring the Partnership for County Health Care Costs Act of 2009, which repeals the inmate exception for those in custody pending disposition of charges, should be incorporated into health reform legislation.”
The cost of providing jail health care services has increased dramatically over the years due to a number of reasons, including infectious diseases, substance abuse treatment and mental illness. This legislation would help alleviate some of the county jail health care cost by allowing inmates who received Medicaid, Medicare, SCHIP and SSI to continue receiving benefits until they are convicted of a crime. Under current federal law, a person who is in custody pending disposition of charges loses benefits until the individual is no longer in custody. HR 2209 currently has 23 cosponsors including two member of the Texas delegation — Rep. Michael Burgess and Rep. Kay Granger. For more information, contact Rick Thompson at (800) 456-5974 or rickt@county.org.
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