WASHINGTON, D.C. — The head of the Texas Hospital Association yesterday implored the Centers for Medicare & Medicaid Services not to jeopardize the state’s uncompensated care pool.

“We have built a safety net that works,” THA President and CEO Ted Shaw told me yesterday, between sessions at the American Hospital Association’s Annual Membership Meeting in Washington, D.C. “It’s those people who benefit from the safety net who would be hurt.”

The pools were created through Medicaid waivers, and CMS has announced it will review the waivers of at least four states — Florida, Kansas, Tennessee and Texas — that have failed to expand Medicaid coverage. The Obama administration says Medicaid expansion is a more effective way to increase access to health care for low-income patients than are the pools, which provide special funding to cover providers’ uncompensated care costs.

However, Medicaid expansion is difficult or impossible to achieve in states with particularly conservative legislatures like Texas. That means the uncompensated care pool is essential to the mission of safety net hospitals, Shaw said.

“It is critical to get CMS to understand that we are compliant” with its standards for the program, he said, adding that “Texas hospitals embrace quality improvement” to enhance care and value for safety net patients and all other patients in the state.

Texas’ $3 billion pool is set to expire on Sept. 30, 2016.

Shaw is also wary about the Supreme Court’s upcoming ruling in King v. Burwell. In Texas, about 900,000 are now getting subsidies through the federal insurance exchanges. The Texas legislature does not support a state exchange. If those people lose access to coverage, Shaw said, they would be more apt to seek non-emergent care in overstressed hospital emergency departments, where costs are higher. Or they might not be inclined to seek care until their conditions are dire.