Trump Needs to Build, Not Cripple, Health Care Capacity

Americans, by the hour, are quickly coming to realize the importance that hospitals and health care providers play when facing public health emergencies like COVID-19.

The World Health Organization has officially declared a pandemic due to COVID-19 and the American health care system is under serious strain. It may ultimately reveal several critical shortcomings: People are demanding tests to see if they are infected, but there aren’t enough tests available.  Individuals with symptoms are seeking care in their local emergency room, but jeopardizing care for others with other types of medical emergencies because there aren’t enough providers to handle the surge. Medical supplies such as N-95 masks are in short supply, placing our frontline health workforce at greater risk of infection. The traditional public health infrastructure has been ignored and defunded for years – and it’s all coming to a head when we need all these resources (and more) to meet demand.

Now – imagine this pandemic happening with shuttered or dramatically reduced hospital and clinical services.  It could happen in the future – and most likely will, unless federal policy changes soon. 

The Trump Administration, back in November, proposed a federal regulation innocuously named the Medicaid Fiscal Accountability Regulation. Known as MFAR, this draft rule will strip states often of billions of dollars in annual Medicaid funding. Red states. Blue states. All states will be negatively affected. There are no winners under MFAR. All states all have critical hospital services and providers that are currently rising to serve the steadily increasing cases of COVID-19. They survive on the very Medicaid funding that MFAR will strip away. 

States that have chosen not to expand Medicaid under the Affordable Care Act will be even more harmed under MFAR. These are states with higher uninsured rates, and numerous studies show that families without health coverage pose an even greater risk to the broader public health because they are less likely to seek care when they can’t afford it. With COVID-19 continuing to spread daily, the critical services delivered by public hospitals and clinics in states with high uninsured populations are even more important.  According to a recent article in the Houston Chronicle, Texas hospitals estimate they will lose approximately $11 billion in funding under MFAR. States like Texas, Florida, Oklahoma, and Georgia have some of the highest uninsured rates – and when the uninsured in those states need care, they go to their local emergency room as a last resort. If MFAR is finalized, patients, both insured and uninsured, won’t have hospitals because they will have either closed their doors or dramatically reduced their services.  This is especially likely in areas served by rural hospitals with no alternative for hundreds of miles.

Governors from all states are seeking relief from this proposed rule. The growing economic fallout from COVID-19 is adding to the fiscal uncertainty for state budgets.  President Trump has an opportunity to change course in these uncertain times and prevent MFAR from being finalized. He has made several bold decisions in our current public health crisis and he should make another demanding that his own agency pull this rule and preserve state Medicaid funding as is.  If he does not, Congress must act.  It will protect critical services for all Americans. It will continue to allow hospitals and doctors to treat patients, including for future public health emergencies.  MFAR should be scrapped now. 

Jennifer Kent, MPA has more than fifteen years of extensive health administration and policy experience in California that spans over three gubernatorial administrations and encompasses both private and public delivery systems. As Director, Kent oversaw the second largest public healthcare system in the nation with an annual budget of over $100B and serving approximately 13 million Californians.  She oversaw the administration of twenty-four managed care plans as well as 56 county behavioral health plans.  Kent has also held leadership roles in the Health & Human Services Agency and Governor’s offices as well as experience in the private sector as a lobbyist, consultant and association executive