MHA Press Room

Medicaid expansion rally at the Capitol, March 27, 2013: Remarks of Sam W. Cameron

Good morning. Thank you for having me here today. I am Sam Cameron, President/CEO of the Mississippi Hospital Association. We represent over 100 hospitals in our state and over 90,000 employees who work in our facilities.

I want to say right from the start here that the Mississippi Hospital Association supports Medicaid expansion and we have consistently said we are for Medicaid expansion. Our support is required, first, because of the compassionate healing ministries we are charged with on behalf of those among us that we see and treat every day. But we also support expansion because of the financial realities our hospitals now face.

No matter what you think about Obamacare, the federal law—the law of the land--contains reimbursement cuts to Mississippi hospitals over the next 10 years. These cuts are hard-coded in federal law and they are not subject to administrative interpretation or wishful thinking. They will occur.

To put these cuts in perspective . . . Most recent cost reports reveal that 70 of Mississippi’s 106 acute care hospitals had a profit margin of less than 5 percent. Let me repeat that. . .70 of 106 hospitals had profit margins of 5 percent or less. The federal cuts we already know about represent a negative 11.5 percent of total Medicare fee-for-service-revenues to all hospitals in the state. And that number does not include the projected Medicare DSH cuts of over $663Million in Mississippi that begin October 1st. Those cuts do not include the $200 Million Mississippi hospitals will no longer receive in Medicaid DSH reimbursements, also beginning October 1st.

It’s been suggested by some that the state will somehow make hospitals “whole” for these cuts in federal reimbursements. Those who make that suggestion are unaware that the total cuts to Mississippi hospitals—again, cuts that are hard-coded in the federal law—total over $4.2 BILLION over the next 10 years. So it’s time we put that bit of “wishful thinking” behind us.

It’s time to put People over Politics.

The first people I want to talk about work in your community hospitals as nurses, janitors, managers, medical coders, and cafeteria workers. Many of them work in small, rural hospitals that are struggling to keep their doors open already, and they face potential lay-offs if we don’t expand Medicaid eligibility.

It’s time our public officials show they care about hospital employees who may be laid off. Please, put People over Politics and allow a vote on Medicaid eligibility expansion.

I’m also here today to tell you about people who do have health insurance. An American Academy of Actuaries study recently concluded the costs of private health insurance could rise in states that opt out of Medicaid expansion. According to an analysis from Jackson Hewitt Tax Service Inc., the associated costs to employers of not expanding Medicaid could total anywhere from $876 million to $1.3 billion in the 22 states that are either opting out or are leaning that way.

And apart from the cost of care, the most critical issue is access to care. The most critical issue is that when we cut hospital staff and hospital services, we are jeopardizing access to care for all Mississippians, whether on Medicaid or not, whether you have private insurance or not. Those services aren’t eliminated just for the uninsured, but for everyone.

People over Politics. . .People over Partisanship . . . People over Wishful Thinking.

To all of our elected officials I respectfully request: Please, on behalf of all of us who serve those who serve others—have a debate and vote on Medicaid expansion as soon as possible.

MHA Press Conference on Medicaid - 3/11/2013

Transcript of statement read by Claude Harbarger during the press conference:

Today Governor Phil Bryant and Claude Harbarger, Chairman of the Board of Governors of the Mississippi Hospital Association, released the following statements:

Governor Phil Bryant said, "After meeting with a number of the state's hospital leaders and discussing potential impacts of federal mandates on their ability to continue to serve our state's health care needs, we have come together in good faith to work out a possible solution to our funding issues. I recognize the situation facing our hospitals and my administration is committed to helping resolve those issues. While I oppose the expansion of Medicaid in our state, I appreciate the hospitals' willingness to sit down with me and my team to discuss alternatives to solving these issues."

Claude Harbarger, Chairman of the Board of Governors of the Mississippi Hospital Association, said, "We are grateful to the Governor for sitting down with us and discussing this very complex issue. We have agreed to begin working together immediately to seek solutions to the very significant business challenges facing our state's hospitals and other health care providers. We must arrive at solutions in this calendar year or face significant reductions in health care services in the State of Mississippi. We look forward to working with Governor Bryant and his team in the days ahead."

Statement of Gwen Combs, MHA's VP for Policy:  Download 20130311095437626

For more information, contact Shawn Rossi at (800) 289-8884, (601) 368-3237 or srossi@mhanet.org. 

MHA Official Statement: Supreme Court Decision on ACA

Today’s US Supreme Court decision only provided clarity to the legal questions surrounding the Affordable Care Act. Significant policy questions are left unresolved and further complicated by today’s ruling, and they must be addressed by our state’s lawmakers and health care officials.

Most Mississippians are unaware that major revisions have already been implemented to impact health care delivery in the state. Many of these revisions are not contained in the Patient Protection and Affordable Care Act.

For example, there are current Federal provisions that contain reimbursement cuts to Mississippi hospitals totaling $5 Billion over the next 10 years. Mississippi’s 116 hospitals are already paying over $250 Million each year in “provider taxes” to fund the state’s Medicaid program, and these additional Federal cuts to hospitals will be devastating.

Some public officials have already stated Mississippi cannot afford the Medicaid eligibility expansion provided for by the Act. As taxpayers and major employers in Mississippi, hospitals certainly understand and appreciate that position.

However, failure to expand Medicaid eligibility will leave just under 200,000 Mississippians with no health care coverage at all. These Mississippians will be left “in the gap” - not eligible for Medicaid and not eligible to purchase health insurance through the health insurance exchange. The result could be devastating. Hospitals cannot be expected to treat such a large volume of people with no expectation or prospect of payment for those services. The result could very well mean the closure of many of our community hospitals. Clearly, these are burning policy issues that must be addressed fairly quickly.

MHA will be calling upon our Congressional delegation and all state leaders to address the critical issues our hospitals will face as we continue to provide jobs and quality health care in the communities we serve. In the meantime, hospitals will continue to do what we do: care for sick people and focus on quality and efficiency in delivering that care.

MHA Official Statement: 13th Annual HealthGrades Hospital Quality in America Study

HealthGrades, a for-profit health care ratings company, recently released their 13^th Annual HealthGrades Hospital Quality in America Study. (Jump to page 92 in the report to see Mississippi’s state scores.)

Their “grades” are from 2007-2009 Medicare data. HealthGrades offers very limited information for public use through its Web site, although more detailed information may be available for purchase. 

"We think HealthGrades provides one view of the health care picture. But it's not the whole picture,” said Marcella McKay, PhD, President/CEO of the Mississippi Hospital Association Health Research & Educational Foundation. “They have chosen a few areas to compare across the state’s Medicare population. It can be a helpful consumer tool, but should by no means be the only tool.”

Health care performance data can be obtained from multiple sources, including state and federal governments, national accrediting bodies, research organizations, professional associations, health plans, employers, vendors that pool data from multiple plans or employers, and directly from providers. All of these entities “grade” hospitals on different measures in different ways. As a consumer, it’s important to understand what is being measured (and thus what is being “graded”) in order to determine if the information is meaningful to you.

In 2005, the U.S. Department of Health and Human Services, in conjunction with the Hospital Quality Alliance, launched the Hospital Compare Web site to provide in-depth information on quality at hospitals across the country. All of the information is free and can be found at www.hospitalcompare.hhs.gov.

Statement of Sam Cameron of MHA on reauthorization of Medicaid at June 30th press conference

Statement of Sam W. Cameron, President/CEO, Mississippi Hospital Association

Good Morning. I’m Sam Cameron, President of the Mississippi Hospital Association. 

Last night around 11:00, House and Senate negotiators reached an agreement with the Executive Branch regarding Medicaid funding and reauthorization of the Division of Medicaid.  I was not here last night when that agreement was reached.  An MHA staff member, though, was here and he had a direct conversation with Governor Barbour and his Chief of Staff.  

In that conversation, Governor Barbour made it clear that MHA had to endorse the agreement or he would not issue the call to reauthorize and fund the Division of Medicaid. 

He made it clear that the bill would have to be adopted by both chambers last night (remember, this was around 11:00 p.m.) or he would not issue the call for a Special Session to extend the Division of Medicaid before it “sunsets” tonight. 

He made it clear, in no uncertain terms, that if the bill was not passed last night, hospitals would face far more drastic measures from the Governor’s Office if he were to run the Division of Medicaid by Executive Order.

Since neither MHA nor the Legislature met those deadlines or conditions (and since the Governor has obviously had time to “sleep on it,”) I am not here to respond to the Governor’s threats. I am here to address what I understand to be in the agreement reached between the House, Senate, and Governor Barbour last night.

My understanding is that all of MHA’s requested protections are included in the agreed-upon bill. If that is the case and we are trying to verify that, this is certainly something we can endorse.  But, as I said, that endorsement is subject to verification.

I understand there are sufficient taxes levied on hospitals that will finally provide the Division of Medicaid with a permanent source of funding, or for at least three years. While the current Division of Medicaid is yet to demonstrate its ability to plan, project, and administer any budget, we accept and endorse the tax amounts and assessment methodologies contained in the bill.

I want to warn everyone that there are hospitals who cannot afford to pay the tax provisions in this bill. I want to warn everyone that service and staff reductions in local hospitals may occur as a result of this bill. I want to warn everyone that, regardless of the amount of taxes contained in this bill, the Division of Medicaid will continue looking for additional taxes or cuts in services in the near future.

To protect the 600,000 of our most vulnerable citizens who depend on Medicaid for their health care, to protect the interests of hospitals who provide that care, to preserve as much as possible the economic health of those cities and towns in which hospitals are the largest employers, and —most importantly—to prevent Governor Barbour from trying to run the Division of Medicaid by Executive Order, I ask members of the Mississippi House and Senate to adopt this bill.

 

Statement from Sam Cameron on Medicaid reauthorization

A Statement from MHA President/CEO Sam Cameron:

Because of the Governor’s refusal to call a Special Session of the Mississippi Legislature, it appears the Division of Medicaid will cease to exist after midnight on June 30, 2009. The Governor’s lack of action will have disastrous results for Medicaid patients and all health care providers who serve them.

While most legal experts agree the Governor can “run” the agency without reenactment of the Division, they also agree the Legislature cannot appropriate funds to an agency that does not exist. 

Pure chaos will result.  

For example, any payments to Medicaid staff or vendors after July 1st would be considered illegal gratuities, leaving the Governor with no staff to run the program.  Since there will be no Division of Medicaid, there will be no authority by which the state can collect provider taxes or draw down federal matching funds, leaving the state liable for 100% of provider payments. There is also the possibility the state would have to refund the $190 million it has already received in federal Medicaid stimulus funds.

Further complications result from the Division of Medicaid’s recent notification that it will not reimburse health care providers for treatment of Medicaid patients until the beginning of the new fiscal year.  If the agency does not exist as of midnight on June 30th, there will be no agency to pay providers for the care they extended.  Providers would then be forced to sue the State of Mississippi to recover cost of those services which, according to one estimate, could be as high as $150 million.

Many hospitals and other health care providers have already informed their vendors they will not be paid until the providers are reimbursed by the Division of Medicaid.  These delays impact the health and viability of thousands of small businesses across the state.

Beginning tomorrow, auditing firms retained under contract by the Division of Medicaid to audit hospitals will be asked to begin terminating their work with an expected departure date of June 30th.  Since the contractual agreements under which such firms are retained will be nullified with the dissolution of the Division, hospital auditors will have no standing to be in health care facilities (unless they require medical attention).

While these arguments address the “economics” side of the Governor’s inaction, MHA is most concerned with the “human” side.

Also beginning tomorrow, many hospitals will begin informing their Medicaid patients that, if the Division of Medicaid is not extended prior to July 1st, the beneficiaries may become liable for the total cost of their care.  No patient will be denied care or treatment by any hospital, but without the existence of the Medicaid program, beneficiaries will be considered “private pay” patients responsible for the whole cost of their treatment and care.   Loss of coverage will not be limited to just hospital services but will include all Medicaid services, ranging from nursing home care to physician visits, from prescription drugs to dialysis centers, from home health services to special needs children, from nurse mid wives to psychiatric treatment facilities.

Medicaid recipients - those among us who are most vulnerable and most in need of our care and compassion - should not be made victims of this stalemate between our Legislative and Executive branches.  On behalf of the 600,000 of our fellow citizens who depend upon continued Medicaid coverage, we implore the Governor to call the Special Session to reauthorize the Division of Medicaid before it expires at midnight on June 30th.

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MHA Official Statement: Certificate of Need

Mississippi currently uses the certificate of need process for hospital projects to control costs and avoid duplication of services. It is the Mississippi Hospital Association’s position that if one hospital must go through this mandated certificate of need process, then all hospitals should be required to follow the same rules. Projects should not be allowed to be “cherry picked” through legislative measures and bypass or ignore the official state process.

Sam W. Cameron
President/CEO
Mississippi Hospital Association

Print-ready four-color photo of Sam Cameron: Download samcameron4c.jpg

MHA Statement: HB 1013 dying in committee

HB 1013 would have provided $174 million in new revenue for our state’s Medicaid and trauma care programs through a $1 cigarette tax. We think it’s a shame that the bill never even made it out of committee, as Mississippians deserve to know where their senators stand on this important public health issue. Unfortunately, it has become an issue of right or left instead of right or wrong.

Medicaid spends $264 million on tobacco-related health care expenditures. The state's current excise tax on cigarettes is the 49th lowest in the nation. It just makes no sense to say you are against a tax on cigarettes (which sends people to our state’s hospitals) to fund the Medicaid program and for a tax that could shut the doors of your local hospital that provides that care when needed.

Letter to the Editor/Op-Ed Piece: Sam W. Cameron, Mississippi Hospital Association

By Sam W. Cameron
President/CEO
Mississippi Hospital Association

Governor Barbour presented his 2008 State of the State address to the Mississippi Legislature this week. A major topic of the Governor’s address was the financial situation of Mississippi’s Medicaid program – predicting an $86 million deficit for the current fiscal year and an additional projected need of $168 million over current appropriations for state fiscal year 2009. 

In his address, the Governor indicated that he would again attempt to pass legislation authorizing a tax on the sick people of Mississippi through a gross revenue tax on hospitals. Fifty of our state’s hospitals (43%) currently operate at a zero or negative profit margin, and this proposed tax has the potential of causing cuts in services and the loss of jobs in communities statewide. Because of this potential negative effect on hospitals and the communities they serve, the Mississippi Hospital Association will again oppose this ill-conceived tax. 

Governor Barbour also indicated that he will attempt to cut the amount and duration of services currently mandated in the Medicaid statutes. Considering the fact that, based on Medicaid’s own estimates, hospitals are already paid approximately 13% less than their allowable costs to treat Medicaid patients, there is no legitimate financial basis for cutting reimbursement even further.  Taking away a sick person’s Medicaid card or cutting the amount of services for which Medicaid pays will NOT stop that sick person from accessing health care - it will simply shift the burden of cost from a 74%/26% Federal/State match to 100% State monies. 

This tax issue is being framed as a public hospital versus private hospital debate. The conception is that public hospitals provide the lion’s share of uncompensated care in our state and private hospitals are benefiting from this. This is simply not true. Based on 2006 cost report data, Mississippi hospitals provided over $631 million in uncompensated care – of that total number, public hospitals provided 50.68% of the uncompensated care and private hospitals provided 49.32%. (And note that Barbour’s gross revenue tax would also include a tax on this uncompensated care.)

This is not a public hospital versus private hospital issue. Many of our state’s public hospitals are not considered disproportionate share hospitals (DSH). Some of our private hospitals are. This is an access to care issue that affects all Mississippians. Any hospital that has an emergency room is mandated by federal law to provide care to all who come through their doors – whether they have insurance or not. This tax severely hurts three-quarters of those hospitals with open doors.

Mississippi’s hospitals are already paying significant dollars into the Medicaid program.  Through currently mandated bed taxes, gross revenue assessments, and inter-governmental transfers, hospitals are paying over $140 million annually to the Division of Medicaid. Contrary to statements that you have heard regarding “not raising anybody’s taxes” in the past four years, the fact is bed taxes on hospitals have more than doubled – going from $1.50 per bed, per day, to $3.25 per bed, per day. For those health care systems and facilities that have associated nursing homes, bed taxes have more than tripled – going from $3.00 per bed, per day, to $9.27 per bed, per day!

And this is most definitely not just a tax on hospitals – it’s a tax on anyone who works at a hospital, anyone who depends on a hospital for quality health care and any business that provides health care insurance to its employees. Hospitals exist to serve our community, but we have to be able to keep our doors open – to make payroll, to have money available for capital and technological improvements, to continue to provide much-needed services, like emergency care, that often end up costing money to operate but are critical to our communities.

The Division of Medicaid’s leadership has made the statement that there are only two options for funding their deficit:  1) cut services or 2) tax hospitals.  We believe there are other options that should be explored and the Mississippi Hospital Association stands ready to cooperate with the legislature, the Governor’s Office, and the Division of Medicaid to explore these options.

Addressing Mississippi’s Nursing Shortage: Taking the First Steps Toward Preparedness

In 2005, millions of people tried to prepare for Hurricane Katrina and we all watched at the crippling of a region due to a lack of emergency and health system preparedness. Today, the urgency for Americans to prepare for the next disaster has never been greater. Across this state, local leaders and residents are planning for possible health crises, from pandemic flu to an act of terrorism. However, there is one issue that will make the response to emergencies even more difficult. It is the shortage of experienced nurses.

We all count on nurses for the personal, quality care they provide when we are sick or injured. This care is currently threatened by the ever increasing shortage of trained and experienced registered nurses. A recent report by the Trust for America’s Health indicates that 40 states face both a current and future shortage of nurses. Mississippi is one of those forty states. In October 2006, the Mississippi Office of Nursing Workforce conducted its ninth annual survey of hospitals. The hospital registered nurse vacancy rate increased to 9.1% in 2006 from 7.9% in 2005. The nursing shortage makes it difficult for our healthcare sector to meet current needs. In any kind of emergency, the presence of registered nurses will be key to the ability to provide care for an influx of additional patients, many disabled, seriously ill or injured.

Although Mississippi is not alone in struggling with this problem, the Mississippi Hospital Association Health, Research, & Educational Foundation (MHA Foundation) through the Mississippi Office of Nursing Workforce (ONW) is taking the first step towards finding a solution. A unique partnership has been formed to develop solutions to establish a stable, adequate nursing workforce to prepare for whatever issues we face. This partnership is part of a national program, known as Partners Investing in Nursing’s Future, led by the Robert Wood Johnson Foundation and the Northwest Health Foundation, to encourage local foundations to act as catalysts in developing grassroots strategies to address the nursing shortage.

The MHA Foundation, ONW, and the Mississippi Nurses Association have come together to address one of the root problems contributing to the nursing shortage - the nursing faculty shortage. The Mississippi schools of nursing report an anticipated 35.5% faculty vacancy rate by the end of the 2008 – 2009, according to the Southern Regional Education Board on Collegiate Education for Nursing survey of schools of nursing.

The Mississippi Critical Nursing Faculty Shortage Initiative is a multi-dimensional approach to increase and retain nursing faculty that more accurately reflect the ethnicity and gender of our population by the following objectives: 1) develop an innovative, accelerated educational path to a nursing faculty career; 2) develop an evidence-based image and recruitment campaign to showcase nursing education as a desirable career; 3) develop multiple adjunct faculty roles with formal relationships between education and service; and 4) improve education and clinical workplace cultures.

One of the goals of the Initiative is to develop a pilot project between service and education to be used as a model across the state. Hospitals and schools of nursing in the Jackson, Mississippi area are developing a pilot project. This will allow service and education to partner and develop adjunct faculty roles. The project will be implemented in the fall of 2007 and then be used in other regions across the state.

Although we’ve only just taken the first steps, the project shows great promise in strengthening the nursing workforce here in Mississippi. Initial research already shows the nursing community is eager to embrace these new initiatives. Hospital nurse executives are interested in providing adjunct faculty, classroom space, and financial support. Also, most nurses are interested in obtaining an advanced degree which would allow them to teach.

As we mark National Public Health Week, April 2 – 8, the Mississippi Hospital Association Health, Research, & Educational Foundation is committed to working with our community to address the health issues that face Mississippi, including ensuring that we have a prepared nursing workforce.

Nurses are a cornerstone of our health care system and need to be skilled, appreciated, and empowered to enjoy long-term careers. Efforts like this are necessary to ensure that an abundant nursing workforce is in place when we need it. Without trained and experienced registered nurses, we could face the effects of a Katrina-like disaster again in Mississippi. This is not someone else’s problem to fix. Here’s what you can do to help: As a member of the community, you can be an advocate for encouraging our legislatures to appropriate funds for faculty salaries as well as innovative paths to nursing education.

Debbie Logan, RN, MHA is the Project Director of this Initiative at the Mississippi Office of Nursing Workforce. Email her at dlogan@monw.org. Information about this program can be found at www.PartnersInNursing.org.

*Note to Editor: For more information on the Trust for America’s Health Report – Ready or Not? Protecting the Public’s Health From Diseases, Disasters, and Bioterrorism 2006, visit http://healthyamericans.org/reports/bioterror06/