Our job is health care; but legislators on both sides need to fix regulatory, coverage gap problems

By Toni Ardabell

The mission of Bon Secours is to bring health and wholeness to the individuals and communities it serves. Our heritage compels us to focus on the underserved, who are often uninsured.   Many of our facilities are positioned in communities where we can provide good help to those most in need. Our faith calls us to heal the entire person — body, mind, and spirit– regardless of his or her ability to pay.

We are a Catholic-based mission-centered not-for-profit health organization that relies heavily on Medicaid and Medicare reimbursements to offset the services we provide for no pay, and to maintain our high standards of care and quality workforce.

The Patient Protection and Affordable Care Act (ACA) is not working for our Virginia hospitals because it has significantly reduced Medicare and Medicaid reimbursements, albeit mostly to subsidize private coverage for those in need, and because Virginia has chosen not to close the coverage gap.  The American Health Care Act (AHCA), in its last form before the U.S. House of Representatives ceased considering it, would have been even worse for Virginia hospitals.  The AHCA would have taken insurance coverage away from thousands of Virginians, and reimbursements would have been even lower.  We were glad that the AHCA, in its last form, did not become law.

The ACA is the law of the land, and we believe that Congress must reform it. In the meantime, we believe that the Virginia General Assembly and Governor must create a path for closing the coverage gap in the Commonwealth.

According to the Virginia Department of Medical Assistance Services (DMAS), Virginia is currently forty-seventh in the country in per-capita Medicaid spending.  According to the Virginia Hospital and Healthcare Association (VHHA), each day expansion does not occur, we leave $6.2 million in federal funding on the table.  Failure to expand has resulted in $6.9 billion of Virginia taxpayer dollars staying in Washington, D.C. between 2014 and 2018, and a missed opportunity to insure more than 250,000 Virginians.  Not expanding Medicaid has also put tremendous pressure on Virginia general fund spending for mental and behavioral health programs; expansion would have freed up $800 million in Virginia’s budget.

In fiscal year 2016, our Medicaid shortfall for the Bon Secours Richmond Health System alone was $28.7 million. In the same year, we provided $33.2 million in charity care, and invested $20.3 million through our public health and community development programming in the greater Richmond community.  Too many more years with the same coverage gap would likely lead to major reductions in these critical programs that help provide a more stable future for the most vulnerable among us.  Drawing down more federal Medicaid dollars would help our system plug this gap, enabling us to make even more investments in public health, and in the community development projects that support our neighbors.

We have also felt secondary effects from the failure to expand Medicaid.  According to the VHHA,  health care and social services jobs grew 75% faster in expansion states (2.4% versus 1.8%).  This is harmful for the Commonwealth’s economic vitality, and especially confounding in a climate where nursing and staffing shortages are plaguing patients and hospitals.  Failure to expand Medicaid also leaves employers with the burden of subsidizing the costs of hospital charity care.

Medicaid expansion is a cornerstone of the ACA. If we are going to keep them both, equity among states is a must, hospital-related cuts must be restored, and reimbursements must be fair.  We will welcome provisions that demand safety and quality, and compel efficiency, and put reimbursement at risk through a rational pay for performance construct.

Our hope is simply that our representatives in Richmond and Washington, D.C. engage in an open, honest and methodical conversation before attempting to legislate a sea-change in one-sixth of our economy.  Further, we expect they will actively include healthcare professionals who understand the industry in this conversation.  While we impatiently wait to be part of that movement, we will do all within our power to continue providing good help to those in need.

At Bon Secours, we spend no time thinking about whether there is a Republican or Democratic way to replace a hip, improve a patient’s life or deliver a baby.  We believe our elected officials should take this same tact when working to replace the current regulatory regime, improve the ACA, or at least deliver on closing the coverage gap.

Toni R. Ardabell is the Chief Executive Officer of the Bon Secours Virginia Health System.