#FullRepeal Daily Digest

USA Today: More patients flocking to ERs under Obamacare [Similar to how the state of Mass. experienced greater ER volume after its insurance reforms, so too will hospitals around the country as a result of Obamacare]

• It wasn't supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month. That 12 percent spike in the number of patients — many of whom aren't actually facing true emergencies — is spurring the Louisville hospital to convert a waiting room into more exam rooms.
• Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they've seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.
• Hospital officials said they are helping patients find primary-care physicians and hope that helps eventually lessen ER visits. But in the meantime, they said, crowding and wait times may increase for everyone, and Medicaid costs will be harder to control. A report from the Robert Wood Johnson Foundation said the average ER visit costs $580 more than a trip to the doctor's office.
• Studies have shown that Medicaid patients were among the most frequent ER users before health reform, and becoming newly insured only increases ER use by giving an avenue to get treatment to patients who had been forgoing care because they couldn't afford it. A 2007 issue brief from the Kaiser Family Foundation said Medicaid patients comprised 9 percent of the general population at the time but accounted for 15 percent of emergency visits.
• A January study in the journal Science found that getting covered under Oregon's 2008 expansion of a Medicaid program for uninsured adults increased ER use by 0.41 visits per person, or 40 percent relative to visits among a control group. All sorts of visits went up — those for serious problems, as well as "for conditions that may be most readily treatable in primary-care settings."
• Enter Obamacare, which in Kentucky added 330,615 people to the Medicaid rolls by expanding the program to cover residents earning up to 138 percent of the federal poverty level — $15,856 for an individual in 2013.

Boston Globe: UnitedHealthcare to cut doctors for Mass. Seniors [Obamacare's Medicare Advantage changes and cuts will continue to negatively impact  seniors' access to care]

• National insurance giant UnitedHealthcare plans to cut up to 700 Massachusetts doctors from its physician network for seniors enrolled in its private Medicare plan as a way to control costs, according to company officials. For elderly patients enrolled in the plan, the cuts mean they will have to find a new doctor or eventually switch to a new health plan that covers their current doctor.
• In total, UnitedHealthcare will have cut about 35,000 doctors across the country over the past six months, the insurer said; that represents roughly 10 percent of the insurer’s national provider network.

Washington Post: Long waits persist for those applying for Medicaid coverage in many states

• While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed — with some stuck in limbo for as long as eight months, according to officials in 15 large states.
• The scope of the problem varies widely. California accounts for a lion’s share of the backlog with 900,000 applications pending as of early June. The next-biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all. All three states have implemented the health law’s expansion of Medicaid.
• Yet even some big states that chose not to expand the federal-state health program for the poor are seeing backlogs, including North Carolina, with 170,000 applications pending, Georgia, with 100,000, and South Carolina, with 62,000. Florida and Texas, which also did not expand the program, each report fewer than 11,000 in queues. Federal regulations typically require states to process applications within 45 days, and many state applications are still within that period.
• “You will have impaired access to care . . .because often the provider will not see you if you do not have a Medicaid card,” Dorn said. The waits also contradict the Obama administration’s promise that the online insurance marketplaces would bring a “no wrong door” approach to signing up for health care, regardless of a person’s income.

Forbes: ObamaCare's Medicaid Expansion Equals Taxation Without Representation (Are You Listening, Mike Pence?)

• Over and over, the Post editorializes against Virginia Republicans’ senseless refusal to accept the $2 billion in federal funds available under ObamaCare’s Medicaid expansion [“The Virginia GOP’s Medicaid Plan: Just Say No,” May 30]. But who’s being senseless here?
• The U.S. Treasury would raise those funds by borrowing them. It is a mathematical and accounting certainty: if Virginia participates in the Medicaid expansion, the federal debt rises. The burden of paying for the expansion will fall on voters who haven’t even been born yet.
• It’s little wonder that every Democratic politician in Richmond and a few Republicans embrace this opportunity to spend the money of people who cannot vote them out of office. Or that ideologues and special interests are encouraging that impulse. That’s how we got a $13 trillion national debt. What’s amazing is that so many politicians are finally saying no. And for refusing to increase the federal debt, the Post pounds them almost daily.
• Would any members of the General Assembly support the Medicaid expansion if the cost fell on people who could vote them out of office? If it were financed, say, with a $2 billion increase in Virginia’s sales tax?

Modern Healthcare: Hospitals concerned about reimbursement as they prepare for influx of vets

• Hospitals around the country face a tough dilemma: Does their duty to serve U.S. military veterans who are unable to get timely care atVeterans Affairs Department healthcare facilities outweigh the headache of dealing with the VA's relatively low and slow payments? For some, the answer is no.
• Under the VA's new Accelerating Care Initiative, VA facilities must offer a referral to a non-VA provider for any new patients who are on a wait list or have an appointment more than 30 days out. The first referrals were expected to start May 30. Veterans will only be able to seek VA-paid care at private clinics and hospitals in areas where the agency's capacity to expand its own services is limited. The VA did not provide an estimate of how many patients might be referred under the policy.
• … hospitals also worry about the sometimes-difficult bureaucratic process of getting and complying with a VA contract, which usually is required before non-VA facilities can get reimbursed for treating VA patients. The contract process has been so difficult that some hospitals ultimately have turned down the chance to work with VA patients, said Don McBeath, director of government relations at the Texas Organization of Rural & Community Hospitals. “If the VA continues to have a complicated reporting system, convoluted contracts and is more complex to work with than (Medicare), some small hospitals just don't have the resources to deal with that and will decline contracting with the VA,” he said. For the VA's accelerated care initiative to be successful, rural hospitals must participate because 40% of veterans live in rural areas, he added.