Advocate

Advocate

Guaranteeing Access to Care for America’s Vulnerable People

Washington continues to operate in an environment of fiscal austerity. Deficit reduction measures have taken center stage as the driving force for how federal funds are appropriated. Because of this, many lawmakers are focusing on entitlement programs and how they can be reformed to restore fiscal balance. Amid these efforts, the future is now uncertain for Medicaid and other funding streams that ensure access to care for vulnerable people.

NAPH members work with underserved populations and have seen first-hand the benefits that health insurance coverage provides, including coverage through both the Medicaid and Medicare programs. NAPH members also recognize that, as health care costs continue to rise, our nation must find innovative ways to stem these increases while improving the quality of care. These discussions will almost certainly include proposals to dramatically alter Medicaid and Medicare in an effort to address the financial challenges associated with preserving a viable long-term, high-quality health care system. As Congress discusses reforming these programs, NAPH will continue to urge policy and lawmakers to ensure that America’s most vulnerable people can continue to access the care they need.

NAPH will actively advocate against any proposals that would jeopardize the mission of NAPH members – to provide high-quality care for all.

Additional Information and Materials on NAPH’s Legislative Priorities

Inside Advocate

DSHE&MMedicaidProvider Taxes340B Drug PricingSpring Legislative Event Materials

Disproportionate Share Hospital (DSH) Payments
Safety net hospitals use Medicaid and Medicare disproportionate share hospital (DSH) payments to offset the cost of care to uninsured patients and mitigate substantial underpayments by Medicaid. As a result of the Supreme Court’s decision on the constitutionality of the Affordable Care Act (ACA), the Medicaid expansion that was mandatory for states under the ACA now is optional. The future of low-income populations is uncertain and hospitals will continue to experience substantial uncompensated care costs for the remaining uninsured and expanded Medicaid program. NAPH is working with Congress, the administration, and other stakeholders to find a sustainable solution that will ensure the future viability of the country’s safety net.
Special Update: CMS Issues Proposed IPPS Rule for FY 2014 (May 2013)
NAPH conducted a preliminary review of the inpatient prospective payment system proposed rule for fiscal year 2014. Provisions related to Medicare disproportionate share hospital cuts, the hospital acquired conditions reduction program and the readmissions reduction program were among those included in the rule.

Safety Net Hospitals Urge Congress to Reconsider Medicaid DSH Cuts (March 2013)
NAPH and its members urge Congress to reconsider the Medicaid DSH cuts included in the ACA. NAPH and its members are ready to work with lawmakers to devise a DSH policy that achieves federal savings while reflecting the actual level of uncompensated care throughout the country.

Q&A on Medicaid DSH (March 2013)
This members-only document provides questions and answers about the issues facing Medicaid DSH funding and serves as a guide as members reach out to federal and state lawmakers.

Equitable, Sustainable, Reliable Safety Net Financing: Medicaid DSH
(May 2012) This policy brief outlines NAPH's recommendations for implementing the reductions to Medicaid DSH funding specified in the Affordable Care Act (ACA).

NAPH Supports Equitable, Sustainable, Reliable Safety Net Financing (March 2012)
NAPH and its members urge Congress and policymakers to ensure that vulnerable patients are not left behind in delivery system transformations, by crafting future safety net financing policy that recognizes the true cost of care for difficult-to-treat populations and is aligned with broader quality improvement goals.

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Medicaid
Medicaid, a federal-state partnership program, provides health care coverage to more than 50 million people – mainly children, women and the disabled – across the country. Medicaid beneficiaries make up more than one-third of the discharges and more than one-fourth of the outpatient visits at NAPH member hospitals. This is in addition to the more than 30 percent of our ambulatory care patients and nearly 20 percent of our inpatients who are uninsured.

States are currently determining whether or not to expand their Medicaid programs mandated by the Affordable Care Act but made voluntary by the landmark Supreme Court Ruling in 2012. During this pivotal time for Medicaid, NAPH and its members support increased coverage to vulnerable Americans, and NAPH will continue to advocate on behalf of Medicaid-covered patients and work with federal policy makers to improve the program.
The ACA and the Need for Continued Local Funding Sources
This overview highlights the vital role safety net hospitals and health systems play in their communities and the need to have continued local funding sources for the Medicaid program.

NAPH Members Urge Congress to Protect Medicaid (March 2013)
NAPH and its members urge Congress to protect the Medicaid program and oppose any cuts that could impact access to care.

Medicaid Expansion Benefits Everyone (October 2012)
NAPH and its members understand the benefits of the Medicaid expansion, this outline lays out why states that are hesitant to expand should take up the expansion.

Safety Net Hospitals Urge Congress to Reject Cuts to Medicaid (October 2012)
NAPH and its members urge Congress to protect America’s safety net and reject cuts to the Medicaid program, including cuts to DSH payments, provider tax reductions, repeal of maintenance-of-effort requirements and across-the-board cuts in FMAP.

Safety Net Hospitals Urge Congress to Retain State Flexibility in Funding Medicaid (December 2012)
NAPH and its members urge Congress to recognize that cutting provider taxes shifts costs onto states, which they cannot afford. Cuts in provider taxes do not increase efficiency or performance - they only succeed in shifting costs and negatively impacting Medicaid beneficiaries.

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340B Drug Pricing
The 340B Drug Discount Program applies discounts to outpatient pharmaceuticals. Unfortunately, this means safety net hospitals must keep two separate inventories of drugs — one for covered outpatient drugs and one for inpatients drugs, which are not eligible for discounts. Recently, a bipartisan bill was introduced in the House of Representatives that would extend the 340B drug discount program to inpatients and make other improvements. The 340B Improvement Act of 2011, or H.R. 2674, is sponsored by Rep. Cathy McMorris Rodgers (R- Wash.), along with Bobby Rush (D-Ill.) and Jo Ann Emerson (R-Mo.) - and is looking for additional co-sponsors. A similar bill is expected in the Senate soon.
New Guidance on 340B GPO Prohibition (March 2013)
This overview explains new guidance issued by the Office of Pharmacy Affairs (OPA)clarifying earlier guidance regarding group purchasing organizations.

340B Program Benefits Patients and the Safety Net (January 2013)
This one-pager outlines the benefits of the 340B drug discount to patients and safety net providers across-the-country.

Current 340B Issues (January 2013)
This outline provides additional information on the issues the 340B program faces.

The 340B Coalition Recommends Protecting Access to Care for Vulnerable Patients, Supporting Safety Net Providers and Reducing Taxpayer Healthcare Costs (August 2012)
Drafted by the 340B Coalition, a non-partisan coalition of safety net providers that advocates on 340B issues, these recommendations urge policymakers to consider the need to protect access to care, support safety net providers, and reduce taxpayer costs to ensure the future viability of the 340B program.

Safety Net Hospitals for Pharmaceutical Access
Safety Net Hospitals for Pharmaceutical Access (SNHPA) began as an NAPH initiative to increase the affordability and accessibility of pharmaceutical care for the nation's poor and underserved populations. SNHPA is now an organization of over 500 public and private non-profit hospitals and health systems throughout the U.S. that participate in the Public Health Service 340B drug discount program. SNHPA is dedicated to educating its members and others about the 340B program and creating new opportunities for members to save on pharmaceuticals and improve access to pharmaceutical care for vulnerable populations.

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