A strange partnering of reporter Stephanie Mencimer’s efforts to prove Obamacare is working and HCA’s pitch to the Supreme Court to retain the implementation of Obamacare that provides subsidies to enrollees in Obamacare through federally facilitated exchanges illustrates how far illogical arguments and the “facts” supporting them go when it comes to Obamacare.
*Self described as the “…nation’s largest non-governmental health care provider,” Hospital Corporation of America, HCA wrote a brief in support of continuing IRS payments of subsidies to individuals enrolled in Obamacare plan through federally facilitated exchanges, http://hcahealthcare.com/util/documents/hca-amicus-aca.pdf.
*Curiously, the HCA Brief got attention as a sign that Obamacare is working in a February 9th, 2015 article that appeared in MOTHER JONES by Stephanie Mencimer, “America's Largest Health Care Company Tells Supreme Court That Anti-Obamacare Argument Is ‘Absurd’: HCA's Supreme Court brief declares Obamacare is working,” (motherjones.com).
*It’s interesting that the focus of the article quickly turns to money rather than the law at issue which makes Ms. Mencimer confusedly conclude “…that the health care law is helping patients and the company itself,” in a kind of ENDS-JUSTIFIES-THE-MEANS argument.
It’s confusing because just as quickly she attempts to backtrack and use her example of the practical success she sees as a sign that the law must be the reason for such success concluding, “Obamacare is working,” Mencimer, MOTHER JONES, 2/14/15, “America's Largest Health Care Company Tells Supreme Court That Anti-Obamacare Argument Is ‘Absurd.’”
Can you follow this? How can you show that a LAW is working while defending going outside the actual provisions of that law in order to unlawfully change it to make it “work”? Wouldn’t a better sign that the law was working if the provisions of the law were followed and the law worked?
After all, there’s no argument, it is agreed by ALL that currently there is NO provision in all the minute detail of the thousand-pages of the Affordable Care Act for subsidy payments to enrollees through federally facilitated exchanges (in fact the Act does not even mention the term federally facilitated exchanges). Yet it is these subsidies that HCA and Ms. Mencimer are arguing in favor of as evidence that the “law” that doesn’t provide for such subsidies is working.
In other words, an argument that the law is working by pointing out how implementation of the law in a way that is inconsistent with it makes it work is nonsensical, which is my opinion of Ms. Mencimer’s article.
But even ignoring the Affordable Care Act’s provisions, Ms. Mencimer and HCA fail to successfully advocate for their claims of success of Obamacare using the singular “practical” example of HCA as generally representative as "best evidence" that the law is working.
* Mencimer claims that “…that the health care law is helping patients and the company itself,” which IGNORES the individuals for whom the law is NOT working as currently being implemented which is the issue that brought the King v. Burwell to the Supreme Court’s attention to begin with.
It’s difficult to understand how one might conclude that a challenge to the PPACA based on the experience of those who are only subject to the INDIVIDUAL SHARED RESPONSIBILITY PAYMENT because they meet eligibility for government entitlement dollars under the expanded interpretation of subsidy payments is at all related to the singular experience of a huge for-profit hospital at all, but again, Ms. Mencimer gives it a shot.
*Ms. Mencimer pronounces that Obamacare is working and holds out HCA as the best evidence of such working. “Obamacare is working. There's no better evidence of this than a brief filed on behalf of the government in King by the Hospital Corporation of America,” (Stephanie Mencimer, 2/9/15, MOTHER JONES, “America's Largest Health Care Company Tells Supreme Court That Anti-Obamacare Argument Is ‘Absurd’”).
*Yet Ms. Mencimer knows not with whom she partners, (or maybe she does and instead hopes that we don’t.) HCA is a for-profit hospital with a long history of adjusting its practices to maximize its profits.
Consider that on 8/14/2012, “THE NEW YORK TIMES,” reported in, “A Giant Hospital Chain Is Blazing a Profit Trail,” Julie Creswell, Reed Abelson, that “profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California have soared, far outpacing those of most of its competitors.”
More noteworthy, the article reported HOW HCA was beating the system including:
“HCA changed the billing codes it assigned to sick and injured patients who came into the emergency rooms. Almost overnight, the numbers of patients who HCA said needed more care, which would be paid for at significantly higher levels by Medicare, surged,” and “To reduce emergency room usage, HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance,” 8/14/2012, THE NEW YORK TIMES, “A Giant Hospital Chain Is Blazing a Profit Trail,” Julie Creswell, Reed Abelson.
Ms. Mencimer, is HCA really your BEST EVIDENCE that Obamacare is working when as recently as 2012 it was getting press for coding changes and emergency room policies that turned away ER patients in order to boost its profits?
*This is significant because in its brief, HCA points out that it has lost money since changes under Obamacare have reduced its revenue from federal dollars (which in 2012 were attributed to coding changes that made its Medicare payments surge) because of reductions in the disproportionate share payments to hospitals, when HCA says in its Brief, “The ACA has already cut revenues to HCA by approximately $600 million between 2010–2014,” (HCA Brief page 34).
*Then there’s the fact that HCA’s “success” with Obamacare in terms of increasing hospital admissions is OPPOSITE that of most experience under the ACA indicating it’s perhaps a single instance rather than anything meaningful in assessing Obamacare “experience” in general.
“HCA’s significant increases in utilization rates are at odds with a recent report from the Healthcare Cost Institute, which found an overall downward trend in the use of healthcare services,” November 3, 2014, “RevCycle Intelligence,” Jennifer Bresnick, “4.1% Jump in Hospital Admissions Brings Extra Revenue to HCA,” which considers that HCA said that “Same-facility admissions increased 2.8 percent over the past year,” and “same facility equivalent admissions rose 4.1 percent.”
*Finally, HCA claims that the ACA’s focus on PERSONAL RESPONSIBILITY IS WORKING. In its brief, HCA points out that “Exchanges who make cost-sharing expenditures pay on average $390 out-of-pocket per visit for care at HCA facilities. Thus, the availability of subsidized coverage is achieving the congressional objective of promoting personal responsibility,” page 13, http://hcahealthcare.com/util/documents/hca-amicus-aca.pdf.
Did you catch it? Exchanges, (which is reference to individuals on exchanges) WHO MAKE COST-SHARING expenditures…You got it. It’s not stated, but many of the Exchange patients AREN’T PAYING THEIR COST-SHARING. So much for individual responsibility.
In its own research, HCA reports that of the 126,002 claims paid by insurers, with 78,834 patients who OWED cost-sharing, only 42,498 made a payment. That’s only 54% of the Exchange patients who owed money made any payment on their share of what was owed to HCA. Not a huge sign of INDIVIDUAL RESPONSIBILITY SUCCESS.
While it’s unclear what the point HCA is trying to make is or what the point Ms. Mencimer is trying to make, it’s pretty clear to me that it’s not related to the claim that Obamacare is working.
