Two questions permeated the opening day of the National Association of Public Hospitals' annual conference in Chicago on June 23rd. One was the fate of Medicaid. Given the faltering economy, a swing to the political Right in many states, and the end of federal Medicaid subsidies to states on June 30, NAPH Chairman Kirk Calhoun, M.D., president of the University of Texas Health Science Center at Tyler, said that “NAPH is focused like a laser” on protecting the program.

Celinda Lake, president of Lake Research Partners, Washington, D.C., had both good and bad news. She reported that polls show that 54 percent of Americans are unwilling to pay more to help lower-income people obtain coverage. However, 59 percent of Americans believe that preserving Medicaid is “very” or “somewhat” important.

Uwe Reinhardt, professor of political economy at Princeton University, said that radical Medicaid cuts, or turning the program into a block grant, are highly unlikely, adding that the massive expansion of the program planned for 2014 under health reform could be a major opportunity for NAPH members, because many physicians avoid Medicaid patients, who will likely turn to safety-net providers.

However, Bruce Siegel, M.D., the new president and CEO of the organization, warned that pressure to cut Medicaid “could become sharper in the years ahead.”

The other question was whether, if health reform is fully implemented, there will be a need for safety-net providers. Retiring NAPH President and CEO Larry S. Gage said that the same needs that led to formation of the association in 1981 are still present and will be in the future:  Millions of uninsured people, underfunded community services such as burn and trauma care that many private hospitals do not provide, and targeted programs for vulnerable populations.

Professor Reinhardt predicted that the Congressional Budget Office's estimate that only 23 million people will be uninsured by 2019, thanks to health reform, is low, and suggested that the number could be 35 million or higher, which would require the continued existence of safety-net providers. Many employers with low-wage workers will stop offering coverage, he said, because their employees cannot continue to absorb increased cost sharing. He added that newly enfranchised Medicaid beneficiaries and middle-class patients who have transited from being insured to uninsured and are unable to afford coverage will be a strong new patient population for safety-net providers. 

“In the end,” he advised, “you won't become extinct. Washington policymakers, governors, and local politicians are likely to realize that they can't do without you.”

Emily Friedman is an independent health policy and ethics analyst and a regular contributor to Hospitals & Health Networks Daily.