Health & Medicine Policy Research Group hosted a forum, “Health Reform and the Health Care Safety Net: Challenges and Opportunities,” on July 9 to explore the potential impact of health reform on the health care safety net nationally and in Illinois specifically. The forum explored challenges and opportunities presented by health reform in Illinois, and examined the impact on community health centers, safety net hospitals, the health workforce, and vulnerable populations. Speakers included *Michael McRaith, Director, Illinois Department of Insurance *Julie Hamos, Director, Illinois Department of Healthcare and Family Services *Claudine Swartz, Assistant Vice President for Policy, National Association of Public Hospitals and Health Systems (NAPH) *Bill Foley, CEO, Cook County Health & Hospitals System *Philippe Largent, VP for Government Affairs, IL Primary Healthcare Association *Linda Murray, Chief Medical Officer, Cook County Department of Public Health, President-Elect, APHA *Roberta Rakove, Senior Vice President, Government Affairs, Sinai Health System

1. Health Care Reform and the
Safety Net
Priority Issues

2. Major Issues Impacting the Safety
Net
• Coverage Expansion
• Payment Cuts
• Unfinished Business
• Innovations/Demonstrations

3. Coverage Expansion – The Good
News
• Effective January 1, 2014, Medicaid will be
expanded to all individuals under age 65,
including children, pregnant women, parents,
and adults without dependent children, with
incomes up to 133% of federal povery level
• All newly eligible adults will be guaranteed a
benchmark package of benefits
• The federal government will finance 100% of the
expansion from 2014 through 2016, 95%
through 2017, 94% through 2018, 92% through
2019, and 90% thereafter

4. Coverage Expansion – The Good
News
• Premiums and cost sharing credits for
individuals between 133% and 400% of
federal poverty level will make coverage
available for many working poor
individuals
• The law contains a state maintenance of
effort requirement for Medicaid eligibility

5. Coverage Expansion – The Bad
News
• With the exception of a two year bump in Medicaid
primary care physician rates to Medicare rates (2013-
2014) the law does not address Medicaid physician
payment issues for primary or specialty care
• Undocumented immigrants are not part of coverage
expansions. Approximately one third of the uninsured in
the metropolitan area are undocumented Hispanics, and
there are significant numbers of other undocumented
uninsured.
• State maintenance of effort does not extend to payment
rates

6. Coverage Expansion – The
Questions
• What are the implications for the current Illinois Medicaid payment
system?
• Will the State cut rates when the FMAP for new enrollees declines
from 100%?
• Will competition for primary care physicians in all communities
impact the availability of physicians in poor communities?
• What will demand for underfunded specialty services be?
• Is there sufficient capacity, both inpatient and outpatient, in safety
net systems?
• What will be barriers to enrollment?
• How do we change patterns of previously uninsured patients in
accessing care?

7. Payment Cuts – The Good News
• Is there any good news?
• DSH cuts could have been worse
• States and hospitals with higher
percentages of uninsured than the national
average will have a rebate on their DSH
payments

8. Payment Cuts – The Bad News
• Any DSH cuts are significant
• Safety net hospitals are vulnerable to Medicare cuts
• Safety net hospitals without large percentages of
uninsured are more vulnerable on DSH cuts
• Safety net hospitals are vulnerable on cuts related to
readmissions unless funding is available to deal with the
unique challenges of preventing readmissions in high
risk communities
• Many safety net hospitals will require additional
resources to meet quality/value based purchasing
requirements for Medicare reimbursement

9. Payment Cuts – The Questions
• How will rebates on DSH payment cuts for
high percentages of uninsured be
calculated?
• Will payment policies on readmissions and
quality reflect the unique challenges of
safety net hospitals and their patients?

10. Unfinished Business
• 340b inpatient extension – may be dealt with in
a limited way in the tax extenders bill
• Safety net hospital infrastructure needs – capital
and technology – are not addressed in the
legislation
• Adequate payment for Medicaid services
remains in question
• Coverage for undocumented individuals is
excluded from the legislation and may require
comprehensive immigration reform

11. Innovations and Grants
• Opportunities to partner with the State of Illinois
to control costs and improve care through
demonstration projects, including:
– Strategies to reduce readmissions in low income, high
Medicaid communities, including innovative
community based programs
– Strategies to focus on the prevention and treatment of
chronic diseases common in high Medicaid
communities, including asthma and diabetes
– Funding for community care networks serving low-
income communities, such as the Comer proposal –
is authorized in the legislation, and NAPH is seeking
appropriations for these networks