Shutdown and ACA- What’s Next and How Will They Affect the EMS Bottom Line?
History
By now, most likely you have heard that the United States Government is experiencing a partial shutdown. The Trump Administration and Congress reached a stalemate just before the Congressional Christmas break stemming from a disagreement over funding for a southern border wall.
Both sides have dug in their heels and there has been little progress, especially when incoming Congressional leaders for the next Congress celebrated their holiday season by exiting Washington D.C.
What comes next to break the stalemate is anyone’s guess. President Trump has made it quite clear that he will hold out for as long as it takes to secure necessary funding for his campaign-promised border wall.
No pay or furloughs
As a result of the shutdown, approximately 400,000 essential Federal employees will be forced to remain on the job without receiving a paycheck, in the short term. Another 350,000 non-essential Federal staffers were furloughed on-the-spot closing national parks and bureaucratic offices.
Fewer people, fewer actions is the concern for healthcare providers.
For ambulance…
Obviously, the concern within the ambulance industry is what effect the shutdown will have with regards to Medicare and Medicaid reimbursements as they continue to provide the lion’s share of funding. Plus, as if to add even more ambiguity, is the U.S. District Court’s ruling from last week that declared the unconstitutionality of the individual mandate requiring Americans to buy health insurance which for all intents and purposes strikes down the Affordable Care Act itself.
Medicare and Medicaid
It’s important that we all keep in mind that Medicare and Medicaid are considered essential benefits and are not funded within Congressional appropriations. Therefore, those benefits will continue to be paid as will Social Security benefits.
We must all remember that Medicare benefits are issued by contractors, who while paid to perform their functions under contract with the Centers for Medicare and Medicaid Services (CMS), staffers who process claims are not direct Federal employees and thus not directly affected by the shutdown.
Likewise, Medicaid- while funded using Federal dollars, is administered by the individual states and therefore not involving Federal employees subject to furlough as part of the government impasse.
However, it should be noted that any non-claim-processing action involving any one of the CMS Regional Offices may be impacted as those staff members would be potentially affected by a protracted shutdown.
CHIP Concern
There has been some mention of concern regarding the funding for the CHIP or Children’s Health Insurance Program which is coverage for children in families that earn too much to qualify for Medicaid.
Funding for this program actually was exhausted in October. Congress acted on stop-gap funding of $2.85 billion which carried the program into December. Now, the current stalemate in Washington puts the program in jeopardy once again and it is expected that states will not receive their share of funding for the program in the short-term.
While a concern for any healthcare provider, this is much less of a game-changer than if Medicare and/or Medicaid funds would be directly affected.
ACA
What happens with the ACA now that U.S. District Judge Reed O’Connor has ruled against the individual mandate is anyone’s guess.
In court filing on Sunday, December 30th, Judge O’Connor stated that his ruling of unconstitutionality will not take effect while the ruling is reviewed on appeal to the Fifth Circuit Court of Appeals.
It is considered unlikely that the Appellate court will overrule Judge O’Connor, but the judge nevertheless agreed to stay his decision citing the affect on the American public overall until the process plays out.
Ultimately, it is expected that the case will escalate all the way to the Supreme Court where, once and for all, the fate of “Obamacare” will be determined definitively.
Of course, the final outcome of this process while not directly related to the government shutdown, parallels with the current existing uncertainty for healthcare providers. Should the unconstitutionality ruling survive all appeals and the ACA cease as law, what will be the next move for those who rely on the ACA exchange health insurance policies for their coverage? And as a by-product, where will coverage for healthcare providers services come from if patients’ insurance is no longer in place?
Much to Consider in 2019
As you can see, there is much to consider in 2019. We’ll strive to stay on top of things using this space to keep you informed. In the meantime, we strongly suggest that all EMS administrators continually review budgetary items and work together with your billing office to monitor cashflow and trending. Quick Med Claims offers robust reports and KPI measurements for our clients to help them stay ahead of the curve. If your billing office can’t do the same, then give us a call.
