A rule slipped deep inside the Obamacare legislation has left the hospitals most committed to serving the poorest Americans without the ability to fight back when they are wronged by the federal government. Iowa’s Chuck Grassley is leading the charge in the United States Senate to give these hospitals a voice and restore their right to due process.
Disproportionate Share Hospitals — health care facilities that receive compensation from the federal government for treating a large number of indigent patients — rely on a formula concocted by the Centers for Medicare & Medicaid Services (CMS) to reimburse them for some of the free care they provide. Typically, this arrangement works seamlessly. People who may otherwise not receive care are treated, and hospitals are able to recover some of their costs for their good deeds.
Occasionally, however, the CMS’s calculations don’t add up and mistakes are made in the payments the feds make to hospitals. Historically, that hasn’t been a problem. For 40 years, hospitals were able to appeal unreasonable or mistaken reimbursement rates to an independent arbiter. But under Obamacare, that right was taken away.
Obamacare — officially known as the Affordable Care Act — stripped the rights of Disproportionate Share Hospitals to appeal mistakes made by CMS when it comes to payments for uncompensated care. As a result, more than 2,400 hospitals across America have lost their right to due process.
When bureaucratic errors leave hospitals shortchanged for uncompensated care repayments, it can have dire effects on people and communities across the country. Hospitals are often forced to make ends meet by cutting services, trimming staff, or charging higher prices to patients paying out of pocket. Taxpayers are even occasionally forced to bail out the hospitals, which are often owned by nonprofits or local governments.
Disproportionate Share Hospitals are stuck between a rock and a hard place. By law, hospitals can’t turn down people in need of service due to an inability to pay. But those same hospitals now have no way to protect themselves when they’re shafted. Fortunately, there’s a new bipartisan push to fix this problem.
Legislation introduced by Sen. Grassley seeks to restore hospitals’ right to contest significant errors made by the CMS in determining Disproportionate Share Hospital payments. Sen. Grassley is in good company: Sen. Debbie Stabenow (D-MI), Sen. John Cornyn (R-TX) and Senate Minority Leader Chuck Schumer (D-NY) are also co-sponsoring the bill.
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A House version of the bill enjoys similar broad bipartisan support. The legislation would not direct new tax dollars to any hospital or health care provider. It would simply give facilities that provide uncompensated care the chance to ask a court to step in and help make things right if they are subjected to flawed reimbursement formulas. Nearly 300 hospitals across 38 states have already stepped forward to support the legislation and scores more are likely to follow.
It never made sense to strip due process and fairness from a system that oversees millions of tax dollars and can impact the quality of care at thousands of hospitals across the country. And as dramatic changes appear to be looming for America’s the health care system, it will be all the more important to ensure federal bureaucrats are held accountable.
Restoring the right of Disproportionate Share Hospitals to appeal mistakes made by CMS reinstates the checks and balances necessary to protect hospitals, taxpayers and patients.
It’s the right thing to do for America’s hospitals that do the most for those with the least.
• Don Racheter is President of the Public Interest Institute in Muscatine.