September readers of SmartBrief health care newsletters were intrigued by stories showing the endless push and pull between funding challenges and the ability to offer and access care. Physician shortages, staff retention issues and uncertainty about enhanced Affordable Care Act subsidies all figured into the mix.
The future of rural hospitals
What happened: MedPage Today reported that President Donald Trump’s One Big Beautiful Bill Act is expected to have an outsized impact on the ability of rural hospitals to stay afloat and provide needed care. The bill, which limits funding for medical education and reduces federal spending on health care, is likely to make an already tenuous financial situation worse for many of these hospitals. Data from a Chartis report showed that 46% of rural medical centers are operating at a deficit, and more than 400 may be facing closure. Institutions such as the University of Alabama Birmingham are trying to address staff and care shortages with initiatives like satellite campuses and rural medical education tracks, but some experts said more coordinated effort and investment are needed.
What’s next: This month, Dr. Rafid Fadul of Zivian Health wrote in a MedCity News report that the legislation probably will compel rural hospitals to innovate faster than they planned. “OBBBA is a stress test, and the outcome depends on how we respond,” Fadul noted. The Rural Health Transformation Program under OBBBA provides $50 billion in incentives and grants over 10 years to help rural facilities modernize their processes, employ digital tools and try out new care models. “If necessity is the mother of invention, rural fragility might be the mother of transformation,” Fadul wrote.
The fallout from Medicaid cuts
What happened: HealthLeaders Media reported that Medicaid cuts under the OBBBA may result in a $25 billion net revenue hit for US hospitals. Kodiak Solutions research set forth four possible Medicaid disenrollment scenarios, with the most severe level of reduced enrollment causing a 71% net income reduction for hospitals.
What’s next: Kodiak experts suggested that chief financial officers update their forecasting models, improve eligibility screening, cultivate relationships with state lawmakers and spend more on revenue cycle automation to mitigate the effects of cuts.
The impact of premium hikes
What happened: According to an NBC News analysis, Americans with ACA marketplace insurance are likely to see monthly premiums jump as enhanced subsidies are set to expire at the end of this year. KFF research showed that premiums could spiral upward by an average of 75%, and the Congressional Budget Office projected that nearly 4 million people could lose coverage for cost reasons. The subsidies were introduced under the American Rescue Plan Act and extended under the Inflation Reduction Act, but to date they have not been renewed by Congress.
What’s next: Formal notices about next year’s premiums should arrive in people’s mailboxes this month. States also will have to factor in premium increases from insurance companies, leading to what Jessica Altman of Covered California called “a double whammy of premiums going up and tax credits potentially going down.” Cynthia Cox of KFF noted that without the enhanced subsidies, “pretty much everyone who buys their own health insurance is going to be affected” in terms of cost.
A recent Politico report quoted some insurance exchange officials who said it’s likely too late to extend the subsidies at this point. “Congress missed the opportunity to make this decision early enough for us to reset our markets for open enrollment, and to make it clean and easy for people to come in and see premiums that include the savings from the enhanced level of premium tax credits,” said Ingrid Ulrey, CEO of the Washington State Health Benefit Exchange.
The work woes of health staff
What happened: A survey by The Harris Poll and Strategic Education found that 55% of US health care staffers were planning a job change in the next year, either within the same organization or at a different one. Almost half of respondents said insufficient pay and benefits was a main driver of the decision, 48% said they felt burned out and 48% cited a lack of chances for advancement. Eighty percent said they felt taken for granted and 45% said they felt more valued by the public than by their employers. Respondents also were asked for their views on artificial intelligence, with 42% fearing it could supplant some aspects of their work.
What’s next: Retention strategies must emphasize better career development and educational assistance, according to a Medical Economics story on the same survey. Education benefits also need to be more economically feasible, respondents said. Nearly two-thirds of employees said they want to use their employer’s education benefits but could not afford to pay tuition up front and then wait to be reimbursed.