During Tax Bill Debate, Senator Cites Readmissions-Mortality Link

Republican sees JAMA study as evidence of ACA’s ‘deadly unintended consequence,’ calls for repeal of individual mandate.

Speaking from the floor of the U.S. Senate on Wednesday during debate over a GOP tax proposal, Sen. John Barrasso (R-Wy.) cited a recent JAMA Cardiology study as evidence that the Affordable Care Act has come with unintended consequences, at least one of them fatal.

The study that Barrasso mentioned found an alarming link between lower readmissions and higher mortality among Medicare patients hospitalized with heart failure, as HealthLeaders Media reported earlier this month. Medicare made a concerted effort to reduce readmissions among these patients and succeeded, but the program might have inadvertently increased the likelihood that those patients would die, the researchers wrote.

Barrasso placed blame for this increase in mortality on the 2010 healthcare law, which included a provision establishing the Medicare Hospital Readmission Reduction Program.

“There’s a program in the healthcare law that started to penalize hospitals if that Medicare patient was readmitted to the hospital within 30 days after they had been released from the hospital,” Barrasso said. “There are a number of reasons that may happen, but the goal was to penalize hospitals, and the goal—laudable goal—was to give patients better treatment, but that’s not what happened.”

Among the more than 115,000 fee-for-service Medicare beneficiaries studied, the 30-day risk-adjusted readmission rate dropped from 20% before the program was implemented to 18.4% afterward; the 30-day risk-adjusted mortality rate, meanwhile, increased from 7.2% to 8.6%, according to the study’s results.

“The hospitals succeeded in keeping people out to avoid the penalty, but people died in the process,” Barrasso said.

“There is a deadly unintended consequence here of the Obamacare healthcare law,” Barrasso added, calling upon fellow lawmakers to repeal the ACA’s individual mandate, with the eventual goal of repealing the law in its entirety.

Gregg C. Fonarow, MD, a professor of cardiovascular medicine at UCLA who coauthored the study, said his findings suggest the program could put a significant number of patients at risk.

“If we were to extrapolate this to all Medicare beneficiaries hospitalized with heart failure, we are talking about maybe 10,000 patients a year with heart failure losing their lives as a consequence of this program,” Fonarow told HLM.

The study’s findings, however, have been disputed. Kumar Dharmarajan, MD, chief science officer at Clover Health and the lead author of an earlier JAMA Cardiology study—one which reached the opposite conclusion as Fonarow’s work—said the readmissions policy worked largely as intended.

“If readmission declines are harming patients, we would expect to see that the hospitals with the greatest decrease in admissions would have the greatest increase in mortality. We found that there was no relationship,” Dharmarajan told HLM. “To the extent that there was a relationship, it was the opposite. Hospitals that were dropping readmission rates had mortality rates that were improving.”

Even so, the reported link between higher mortality and lower readmissions prompted the Wall Street Journal editorial board to accuse the ACA and its backers of putting patients at risk by foisting a Washington-centric healthcare system onto the unwilling American public.

“ObamaCare effectively enrolled Medicare patients and hospitals without their consent in a mandatory policy experiment—you’ll be better off, trust us—but then neglected to evaluate the adverse effects,” the editorial said. “A drug trial with the same results would have been shut down long ago.”

Although the House passed a tax bill that would keep the ACA’s individual mandate intact, the Senate has been considering a set of proposals that could eliminate the requirement.

The White House, however, has signaled that it would be open both to removing the mandate’s repeal from the Senate tax plan and to backing bipartisan proposals to stabilize the ACA markets. So the final specifications of the Senate’s tax plan remained unclear Wednesday afternoon, as senators debated publicly and brokered deals in closed-door meetings.