WHA, Rural Leaders on Capitol Hill

Focus: Health reform, rural policies

July 21, 2017

 In the topsy-turvy atmosphere in Washington, D.C., a trip to Capitol Hill on July 20 by the Wisconsin Hospital Association and several health care leaders was well-timed, as the U.S. Senate reignited efforts to move a health care repeal/replace bill forward in the coming days.

The group spent considerable time with U.S. Senator Ron Johnson, discussing the state of play on health care reform legislation. Johnson repeated that his approach would be to stabilize the insurance market, including funding the cost-sharing reductions if needed, provide equity for nonexpansion states like Wisconsin, and make more well-informed, analyzed policy improvements before moving forward. In addition to Medicaid funding equity, attendees discussed various provisions in the Senate’s health reform package and the potential impact those would have on ensuring affordable coverage for Wisconsinites.

Senate Majority Leader Mitch McConnell indicates the U.S. Senate will move forward with a vote early next week, though at this time it is not known what actual version of health care reform legislation will be taken up.

"Over the last eight months, WHA has regularly met and discussed with all of our Delegation the impacts on Wisconsin under both the House-passed and Senate-proposed health care reform legislation," said WHA President/CEO Eric Borgerding. "Again this week in Washington, WHA staff and members reiterated our strong objections to legislation that perpetuates, and now could exacerbate, hundreds of millions in Medicaid funding inequities for Wisconsin and penalizes our state for rejecting the very thing they are trying to repeal. Our team also pressed legislators to ensure affordable coverage is available for Wisconsinites through both Medicaid and the commercial market. Without significant improvements in these issues, WHA is urging our U.S. Senators to oppose this legislation."

"WHA appreciates the open door policy we have had with both of Wisconsin’s U.S. Senators during this important debate," said WHA Vice President, Federal Affairs & Advocacy Jenny Boese. "WHA thanks Sen. Johnson and his staff for raising the issue of Medicaid equity and fairness, including his public statements to that effect, his efforts to slow down the Senate process, and his desire to utilize the expertise of Wisconsin providers and WHA in analyzing the bill’s impact on our state."

340B, Medicare Extenders and Other Rural Health Policies Discussed

The group also hit on key policies and programs of importance to rural Wisconsin hospitals, particularly highlighting the value of the 340B drug discount program. The 340B program provides essential drug discounts to a subset of Wisconsin hospitals, including Critical Access Hospitals (CAHs), among others. These discounts are then used to offset pharmaceutical costs for patients, extend access to care to patients among various other ways qualifying entities do exactly what the 340B statute requires—"stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services."

The group specifically discussed the Centers for Medicare & Medicaid Services proposed FY 2018 outpatient prospective payment system rule, which would drastically cut payments to hospitals for 340B drugs.

"These cuts, if finalized, would be devastating to our hospital’s ability to provide pharmacy services to seven very small, rural communities throughout northeastern Wisconsin," Dan DeGroot, HSHS Eastern Wisconsin, told Rep. Mike Gallagher during his meeting. "We know that medication compliance is far higher when an individual has a pharmacy (and pharmaceuticals) available close to home. Our ability to provide this service would not be possible without the 340B program."

Comments on the CMS proposed rule are due to CMS by September 11. WHA will comment in strong opposition to this proposed 340B change and encourage all Delegation members to sign onto several "dear colleague" letters that will be released in the coming weeks.

Attendees also highlighted the importance of continuing both the Medicare Dependent Hospital (MDH) and Low-Volume Adjustment (LVA) policies under Medicare. Both policies expire September 31 unless Congress extends them. Other issues discussed included: problems with CMS’ current "direct supervision" requirement for outpatient therapeutic services, the CAH 96 hour rule and proposed budget cuts to Wisconsin’s Hospital Preparedness Funds.

This story originally appeared in the July 21, 2017 edition of WHA Newsletter