D.C. Consultants Warn CCHHS Board: Congress Will Quickly Repeal Obamacare!

Cook County Health and Hospitals System Board Meeting - December 16, 2016  
  
Significant Topics Discussed:

​Invited to provide a Federal Update, Wash. DC, Legislative Consultants, Susan White and Jonathan Sheiner, predicted the following to a somber Cook County Health and Hospitals System (CCHHS) Board: 

• Jan. 3, 2017, Congress back in session will move to immediately modify the Affordable Care Act (ACA), commonly known as Obamacare.  Using the “budget reconciliation mechanism” the Senate measure can be passed with a simple majority and cannot be filibustered.  Expect passage, signed by the President, Jan/Feb 2017.
• Reconciliation bills are limited to changing laws that affect taxes and spending which covers key elements of Obamacare.
• Predict roll back of federal tax revenue subsidies for ACA plans.
• Expect Medicaid capitation or capped dollar block grant to States, 50/50% federal match for traditional Medicaid is vulnerable including Medicaid long term care.
• Medicaid expansion under Obamacare, federal support will probably be cut from 90% to 60-70-%. 
• CHIP program covering health care for children under the age of 19 will probably be reauthorized.
• Senate will likely confirm Dr. Tom Price (vehemently anti-ACA) as Secretary of HHS. 
• Governors, including Republican ones, are concerned about the financial impact on their States.

CCHHS Board Chair Hammock concluded that if the ACA insurance mandate is eliminated and Medicaid curtailed, many would not purchase/afford insurance and CCHHS would see a massive increase in use of charity programs: CareLink, the newly introduced Direct Access and unreimbursed care.  Director Richardson-Lowry called for an economic impact statement to be available as soon as possible for Board response to various potential fiscal outcomes.

Observations: 
CCHHS metrics reported for Dec. 2016: 

• Year to date income $3,675,000 but (-$212,020,000) with $212,020,000 pension expense included,
• Overtime as % of gross salary 7.9% (goal is 5%),
• CareLink enrollment at 100% assistance 25,714 vs 20,704 in 2015;
• CountyCare (Medicaid) contributing 64.7% to the CCHHS budget. 

These are perilous times for an organization that depends on Federal and State Medicaid/other indigent care payments to stay afloat. 

Chair Hammock commented that Cook County government is not interested in reinstating the tax generated subsidies of the past to bail CCHHS out!

Observer - Susan Kern, MD                                                            Meeting Length: 3 ½ hours