As the General Assembly gets off to a start, hospital officials and lobbyists are planning how to get their message heard by lawmakers.

By Rose Hoban

When Gov. Pat McCrory strode into a packed room at the Embassy Suites Hotel in Cary Wednesday, he was met by hundreds of hospital managers and officials who stood and gave him an extended ovation.

But by the end of his speech to members of the North Carolina Hospital Association, McCrory had failed to say what many of those hospital officials were hoping to hear: that he was ready to expand North Carolina Medicaid, the combined state and federal program that pays for health care for low-income children, some of their parents, pregnant women and many low-income seniors in nursing homes.

“This year it is absolutely crucial that we come up with a Medicaid reform plan that is physician led, in which we understand what the providers need, we understand what the patients need and we also understand the taxpayer’s challenge,” McCrory told the crowd.

Even though McCrory spoke of meeting with the federal Health and Human Services secretary, Sylvia Matthews Burwell, he did not say anything about expanding Medicaid, as allowed for under the Affordable Care Act. Medicaid expansion would provide health coverage to as many as half a million North Carolinians.

Nonetheless, much of the remainder of the meeting Thursday afternoon was dedicated to strategizing ways for hospital officials to talk with business leaders and the public about the role of hospitals in the health care system and the importance of expanding Medicaid.

Legislative losses

Several different studies have indicated that the state is losing jobs and as much as $22 billion in economic activity as a result of not expanding Medicaid.

“We would love to advocate vociferously for Medicaid expansion,” said Cody Hand, vice president of governmental affairs for the Hospital Association, at a session later in the afternoon. “But the message has been given loud and clear that until we reform what we have, there is no hope that we can expand.”

Without Medicaid expansion, hospitals continue to face large numbers of uninsured patients, even as federal payments intended to make up for that lost revenue are being phased out.

And hospitals have lost revenue from state sources too. Over the past three years in General Assembly budgets, North Carolina’s hospitals have met with a series of assessments from the state, cuts to state reimbursement for Medicaid services and reductions in the program’s base rates of pay.

“I think that we need to make sure that they know we can’t bear the cuts anymore,” Hand told the crowd. He recounted how one legislator asked him, “When are you guys going to stop being the piggy bank,” for Medicaid shortfalls.

“We need to let them know we are at our end. It is no longer right for us to fund Medicaid the way we do,” Hand said. “If you recall, more than half the cuts last year were borne by hospitals, and we’re only 18 percent of the Medicaid spend.”

Hand called on hospital leaders to tell local legislators “their story,” letting lawmakers know the importance of having local hospitals. He instructed them to know their numbers on charity care, unreimbursed costs and the mix of payers that includes fewer privately insured patients.

And to that end, television viewers in the state will start seeing more commercials promoting this same message in coming months.

Shaping the narrative

As the Affordable Care Act continues to be implemented, states are expected to have fewer uninsured people, said Mike Boswood, president and CEO of Truven Health Analytics, a company that collects and analyzes data on the health care system.

“Analytically, what we see is that without expansion of Medicaid, the percentage of uninsured in North Carolina in 10 years will be around 9 percent,” Boswood said. “But with Medicaid expansion, that will be reduced to around 3 percent.”

Boswood’s analysis found that currently about 13 percent of hospitals in the state are considered to be “financially vulnerable,” meaning at risk of closing. Already, a third of North Carolina’s hospitals operate either in the red or just breaking even. If proposed state and federal changes are implemented, Boswood said, the number of financially vulnerable hospitals would rise.

For hospital leaders, that means getting legislators, and the public, to support hospitals and to support Medicaid expansion, which will relieve the pressure of unpaid patients on the health care system. But to do that, hospitals need the right messaging, according to Bill Dalbec from APCO Worldwide, a communications consultancy firm. He presented focus group data on how business leaders and members of the public view hospitals, which he said is largely positive.

“Hospitals are very well regarded, they have a good image,” Dalbec said. “[People] talked about the community service, the quality of care that you provide, the fact that you’re always there when you need them, lots of good positive qualities.”

Hospitals also need allies in pressing for Medicaid expansion, Dalbec said, and he argued that members of the public and the business community could be those allies.

“In both the business community and the general public, [there is] very strong support for expanding Medicaid here in North Carolina,” Dalbec said.

He presented  data showing that moderates, liberals and even some conservatives all support expanding the program. Dalbec said the message that resonated most strongly with all of the people he surveyed, across the political spectrum, was that expanding Medicaid was the “right thing to do.”

“It all comes down to community health.… The more people have insurance, the more they have access to health care and the healthier the population is going to be,” Dalbec said.

 

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